tag:blogger.com,1999:blog-17234956154314248092018-11-12T09:33:35.891-08:00Yellow Fever CasebookDescriptions of historic yellow fever cases, especially in Philadelphia and New York in the 1790s.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.comBlogger22125tag:blogger.com,1999:blog-1723495615431424809.post-656585355825640962014-10-26T10:48:00.000-07:002014-10-26T10:48:24.252-07:00Ebola Africa 2014 and Yellow Fever Philadelphia 1793<div align="center"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-CHx_Q-jJ-XM/Ur9ym6eN8BI/AAAAAAAAvUE/V4sPWMEeGxA/s1600/archwharf1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-CHx_Q-jJ-XM/Ur9ym6eN8BI/AAAAAAAAvUE/V4sPWMEeGxA/s400/archwharf1.jpg" /></a></div><br />In the 18th century doctors based their diagnosis on a patient's symptoms. While treating several patients near Philadelphia's Arch Street wharf in August 1793, Dr. Benjamin Rush confronted some daunting symptoms: flushed face, high pulse, excitability bordering on delirium, as well as periods of prostration with cold clammy skin, nausea and stomach pains so severe that doctors induced vomiting and diarrhea if the fever didn't, in one case blood gushing from the nose just before death, and in all cases a yellowish tinge to the skin. Rush concluded that the city was facing an epidemic of yellow fever.<br /><br />Rush spread the alarm, advised preventatives, primarily cleaning up filth along the city's docks, and urged those of his patients he thought predisposed through weakness to get the disease to leave the city. When somebody near his house on Walnut between 3rd and 4th streets got sick, he sent his teenage sons out of the city despite their general good health. He had noticed that many who got the fever badly were teenage boys.<br /><br /><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-CG21Fsb5W88/VE0p3ZERdVI/AAAAAAAAxuI/8xWq6NAcxfU/s1600/phila1762.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-CG21Fsb5W88/VE0p3ZERdVI/AAAAAAAAxuI/8xWq6NAcxfU/s640/phila1762.jpg" /></a></div><br />The bacterial and viral agents causing diseases were unknown in the 18th century, nor was there any understanding of exactly how diseases spread. Today doctors know the viruses that cause yellow fever and Ebola fever and how those diseases spread. So at first glance there is nothing to be learned from the yellow fever epidemic of 1793 that can be applied to today's Ebola fever epidemic. None of preventatives and protocols that Rush used did anything to stop the spread of yellow fever nor would they be of much use in the fight against Ebola.<br /><br />But Rush didn't know he was wrong. He was as confident he could control the epidemic as doctors faced with today's epidemic, provided that people followed his instructions.<br /><br />His confidence is worth contemplating. We can't dismiss it because he fought a more tractable disease. Only its greater mortality makes Ebola fever more terrifying than yellow fever. The symptoms are similar. Both fevers can torment victims with hemorrhaging from any orifice of the body. In 1976, the symptoms of a mystery disease in Africa were so horrible, pathologists assumed the patient died of yellow fever. Instead of isolating that virus from her blood, they discovered the Ebola virus.<br /><br />There is no cure for either disease, but in 1793 many doctors, especially Rush, credited their treatments when their patients survived the disease. They didn't have tests proving they cleared a body of the virus. They didn't know viruses existed. They thought patients were in the grips of an infected environment that they called "mephitic." Rush thought rotting coffee on the Arch Street wharf infected the air there sparking the epidemic. He compounded that mistake when he assumed that the breath and discharges of yellow fever victims infected the surrounding air increasing the contagion. The imperative was to clean up the noxious filth, everywhere, and wrest control of the body from the fever racking it, all the while staying well so he could treat more patients. <br /><br />Rush only touched a patient to take his or her pulse to measure the force of the fever. Before doing that he instructed the patient or a nurse to turn down the bed covers and he waited for what he assumed were pockets of air charged with contagion to disperse. Of course he also had any windows in the room opened and vinegar was sprinkled throughout the room. Rush dipped his fingers in that mild acid before taking a patient's pulse.&nbsp; In the city's newspapers there were many recipes for concocting the best vinegar based disinfectants.<br /><br />By doing all that Rush did not lessen the chance of an infected mosquito biting him and perhaps invited an uninfected mosquito in through the open window. Rush performed those precautionary rituals with confidence though he had no proof other than his survival that they worked. He thought fear of the disease predisposed one to get the disease, as well as too much meat in the diet. During the epidemic, Rush stopped eating meat altogether. When he got the fever, he decided it was because he got overheated while climbing stairs to see a patient.<br /><br />Then as now, rooms where victims died were feared as death traps, but few believed the contagion was confined there. The heat and humidity of late summer made it easy to sense contagion in the streets of the city. Bonfires were set and cannons fired to make the air less contagious. Exploded gunpowder was prized for its medicinal properties. Efforts were made to disinfect anything leaving city. In 1793 mail and newspapers sent out of the city were exposed to wood smoke. <br /><br />The problem presented by any epidemic is that society feels compelled to treat its victims and allow those in infected areas to evacuate, and, at the same time, stop the spread of the disease. Most thought prudence dictated keeping away from anyone sick with the fever. For those far from where the epidemic rage that meant warding off anyone who had been in Philadelphia, even though it was then the capital of country.<br /><br />President Washington was stopped but allowed to go through Baltimore because he did not plan to stay in the city on his way to Mount Vernon. (He didn't exactly flee since he left for a vacation on the day previously announced.) The Secretary of War was not so lucky. He had to wait out a 14 day quarantine before he could go through New York. All refugees from Philadelphia were taken to tents on an island in the harbor.<br /><br />That travelers from Liberia and Sierra Leone routinely fly to Brussels, the administrative center of the European Union, and then on to Washington and New York would have shocked authorities in 1793.<br /><br />Many fleeing Philadelphia found refuge with family and friends in rural areas and villages and towns in nearby Pennsylvania and New Jersey that didn't organize patrols to keep refugees away. There was not a general evacuation of the city. To be sure, the rich and powerful were among the first to leave and many of them were government officials. In that day the federal government had no resources that could help in the crisis. State government controlled the port but, after finding a dead body on the steps of the State House, most state officials left after ordering the port cleaned and then closed.<br /><br />That left the mayor and enough men eager to volunteer to help manage the crisis. Several Quakers comforted victims with no regard for their own safety and died as a consequence. The Society of Friends held their yearly meeting as schedule. To postpone it would thwart the will of God. Members of the French community had lived in what would soon become Haiti where yellow fever was endemic. They assumed that if they didn't get it there, they would not get it in Philadelphia and walked unafraid on the streets of the city.<br /><br />From his close reading of the Bible, Rush believed God would not leave humanity defenseless against any scourge and looking through the medical literature he found that gift from God. Rush persuaded the leaders of the city's African American churches to organize crews to collect and bury the dead and also nurse the sick. He assured them that a doctor's report on a 1742 epidemic in Charleston proved that they would not get the disease.<br /><br />Black nurses found positions in the houses of the middle class and rich. But Rush was wrong. It soon became apparent that any immunity blacks had in 1742 arose from their having once lived in Africa. Many blacks in Philadelphia had been born in that city and some of them succumbed to the disease. The service of those nurses, both men and women, is a shining moment in American history. However, by singling themselves out by that service, all blacks in the city were avoided by many whites fearful of getting the disease.<br /><br />In 2014 foreign governments, including the United States, and international charities have promised to build special treatment centers for Ebola victims. In Philadelphia, the mayor and his volunteers realized the city needed a place to take those poor victims who couldn't afford a nurse. They took over the Bush Hill estate a few miles outside of the city. The owner was in Europe. Donations from individuals and other cities, including New York and Baltimore, helped defray expenses for a fever hospital. Today international aid has been pledged to support the African countries struggling with the disease. One of the richest men in Philadelphia, the French born merchant Stephen Girard, took a personal interest in the hospital and personally visited patients. So far none of the world's billionaires are that committed to fighting Ebola.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-JkCsFixJLS0/VE0opEkVaFI/AAAAAAAAxuA/HBlIMHWmCJw/s1600/Andrew_Hamilton_Bush_Hill_Drawing.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-JkCsFixJLS0/VE0opEkVaFI/AAAAAAAAxuA/HBlIMHWmCJw/s400/Andrew_Hamilton_Bush_Hill_Drawing.png" height="285" width="400" /></a></div><br />Once patients were moved from the sources of contagion in the city to fresh country air, doctors thought that the chance of the fever spreading from the hospital in such an isolated location was minimal. The first fever hospital, an arena closer to the city, just several blocks from the infected area, was almost burnt down by angry neighbors. As it turned out no one working at the hospital got the fever, thanks to the lack of infected mosquitoes in the area. <br /><br />Moving patients to a fever hospital was not universally accepted. Rush thought taking patients there by horse drawn carts was bad for the patient and that they could be cured at home if they used his remedies. Philadelphia doctors and laymen published treatments in newspapers and distributed handbills.<br /><br />Rush urged purging and bleeding, putting his own stamp on treatment popular since the late Middle Ages. He and his apprentices mixed equal amounts of calomel, an inorganic mercury compound, with jalap, powdered extract from a Mexican plant, to make pills for caregivers to pick up and give to patients. Finding enough experienced bleeders able to take the considerable amounts of blood Rush thought should be removed from sick patients was more difficult.<br /><br />After the epidemic Rush opined that "All the knowledge that is necessary to discover when blood letting is proper, might be taught to a boy or girl of twelve years old in a few hours." Today treatment centers are being overwhelmed by Ebola victims. Despairing of being able to get all victims of the disease to treatment centers, health officials in Sierra Leone began distributing instructions on treatment so that patients could be treated at home by family members.<br /><br />Any controversy over the hospital was muted because it was unable to treat the mounting number of victims. The September death rate doubled in early October with over 100 a day dying of the disease. A survey was taken trying to discover the most sickly parts of the city. Just as many Ebola victims live in crowded alleys in Monrovia,&nbsp; so many yellow fever victims lived in the crowded alleys intersecting the squares made by Philadelphia's main streets near the waterfront. However, in 1793 when screens were not put on windows, no class of people could avoid mosquito bites. <br /><br />Fortunately, 1793 timely frosts in late October killed the mosquitoes spreading disease and the epidemic seemed to end as quickly as it started. President Washington did not hug any recovered yellow fever patients (he didn't do hugging,) but he did reenter the city a day before the official all clear was given.<br /><br />There is no indication that a change in the weather will stop the Ebola epidemic. <br /><br />In 1793 the end of the epidemic brought calls for reform. Some ideas like a municipal water system would take time but scrupulously cleaning streets, alleys and wharves was more easily done. But despite that, there was another yellow fever epidemic in the fall of 1797. Hosing the infected areas seemed to limit its spread. At the beginning of the summer of 1798 many thought the city never looked cleaner. Then in August 1798 yellow fever struck with what seemed like twice the virulence of the 1793 epidemic. Cities all along the east coast including New York and Boston also had yellow fever epidemics in 1798.<br /><br /><br />The immediate reaction to the 1798 yellow fever epidemic in Philadelphia was mass evacuation. The city made it official policy. The Society of Friends postponed their yearly meeting. To accommodate the poor the city and businessmen stressed by the economic damage to the city built special camps outside the city. One housed 2,000 people in wooden buildings erected along a grid pattern of streets. Camp organizers did not neglect the opportunity to reform the poor. Rules were posted and enforced by armed guards. People had to wash their "body clothes" and air out their bedding three times a week; food was withheld from those caught breaking those or other rules; repeat offenders were expelled; people in the camp had to get permission to leave; the whole place was surrounded by sentinels. There were schools, churches and doctors on the premises. Able bodied men were employed digging a canal. <br /><br />That hardly limited the death toll which topped 3,000. First Lady Abigail Adams returned to find that four of her domestics had died. President Adams made the epidemics the first topic in his annual message and called for legislation to help states enforce their quarantines.<br /><br />The epidemics ended with the frosts. Supported by all political parties, a citizens' committee continued disciplining of the poor. A crew of 150 volunteer inspectors inspected "several hundred" houses by the end of February sending beds, bedding and clothes of people who had had the fever to the City Hospital to be "fumigated and purified" or destroyed. We've yet to see what measures will be taken in West Africa to prevent a return of Ebola.<br /><br />In 2014, underlying the confidence that the epidemic will end as all previous Ebola epidemics have is the high mortality rate of the disease. Viruses spread more readily when those infected live a longer time. With this epidemic providing a wake-up call, efforts will be made to improve medical care in West Africa and address the problem of crowded living conditions. This could be the last major Ebola epidemic, especially since vaccines are already being tested.<br /><br />But what happened in America after 1793 suggests that the lessons learned from the Ebola epidemic of 2014 might give a false sense of confidence. Viruses don't respect the good intentions of society. There is a vaccine for yellow fever which has not prevented recurring epidemics in tropical countries. <br /><br />No one blamed doctors for misjudging yellow fever. Many died trying to fight and understand it. Rush lost three apprentices that he especially used to attend patients getting new remedies. Rush wanted to make sure that the medicines he prescribed were properly given to the patient and patients were bled as instructed. Then he wanted to know how the patients reacted to the therapy. In scientific papers today, the medical researchers who write the papers include technicians instrumental in collecting data as co-authors. In one paper exploring how Ebola spreads, five of the co-authors died of the fever.<br /><br />After 1798 many, including Rush, overreacted to the persistence and spread of yellow fever. In 1798, alarmed doctors warned that America was possibly condemned to another half century of sickly summers and falls due to "the epidemic constitution of the atmosphere." That concept was as old as Western medicine having been used by Hippocrates to explain epidemics. After studying all known accounts of epidemics, Noah Webster published a book showing how for 2000 years eruptions of volcanoes charged the atmosphere with deadly gases that caused epidemics. Such thinking resonated with many who suffered through the terror of the recent epidemics. The last notable epidemics in the northeast were in 1822. <br /><br />Today we are not strangers to over blowing the threat of future epidemics. If the Ebola virus mutates, some suggest, it may spread from person to person as easily as the common cold, or perhaps, like yellow fever be easily spread by biting insects. We can take some comfort that despite the grip it had on the Eastern seaboard shortly after the ratification of the Constitution, any mutation of the yellow fever virus has kept it farther away. The last sizable yellow fever epidemic in the United States occurred in the Mississippi Valley almost 150 years ago.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com3tag:blogger.com,1999:blog-1723495615431424809.post-14138453883658459462014-01-22T08:37:00.000-08:002014-01-22T08:37:34.862-08:00Oliver Wadsworth: teenager﻿The Drinkers stayed in the city longer than most of their class. Elizabeth chronicled the visits of men who agreed with her husband that there was no need for panic. Elizabeth noted that the death toll in the newspaper was low. Still she wanted to leave. Then Oliver Wadsworth, a teenager staying with the Drinker's daughter who lived a few doors up Front Street, had a chill after dinner on the 17th of August. All the other children in the household were sent to their grandmother Drinker.<br /><br />Dr. Parke examined the boy that night and thought he had "every symptom of yellow fever." He had had a bilious fever the previous summer, so there was some hope that swimming too long in the hot sun had rekindle that old complaint. He was better in the morning. The black man who changed the boy's linens and sheets after a sweat didn't think he had yellow fever. Parke examined him after dinner on the 18th and advised that he be sent to the hospital. He hoped the boy had the disorder "lightly."<br /><br />"Poor little Oliver is gone," a distraught Elizabeth Drinker wrote in her diary, "he appear'd willing to go - he was taken in a coachee, a man sat by his side against whom he lean'd, and a person was sent with them to see that they did not call for any other." The doctor advised the family Oliver had been staying with to leave the city. And Parke's report of the fever's spread finally moved Henry Drinker to make preparations to leave.<br /><br />Two days later, a letter came from Dr. Cooper at the hospital. Oliver had died of "an inveterate yellow fever" after "all possible attention and care." Cooper assured the family that the fever was not contagious, "no one person takes it from another, but that it is in the air, and spreads very fast." The Drinkers sent their plate to the bank vaults, had their servants strip their trees of fruit, gave all but the grapes to the poor families who alone remained in their neighborhood, and left the city.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com2tag:blogger.com,1999:blog-1723495615431424809.post-85461047923602913612014-01-22T08:32:00.000-08:002014-01-22T08:32:12.507-08:00Benjamin Smith: Quaker MerchantBenjamin Smith was finally in a position to take his family out of the city. The conscientious Quaker merchant refused to flee at the first alarm because his business partner was out of the town on a trip and someone had to watch the store. He had offered all the help he could to members of his wife's family who got the fever. Her brother, a doctor, died. The matriarch of her family, his mother-in-law Margaret Morris, had been dangerously. She recovered and warned Smith that the "Destroying Angel" was "within a few doors."<br /><br />Yet they all decided to stay. On Friday Smith explained in a letter that the very health of his family meant they had to stay. Dr. Rush had told Smith's cousin Richard Wells, after he had recovered from the fever, that it was okay for him to leave but not his healthy wife, "for the exercise of riding and keenness of the country air would probably excite into action the infection that might be in her body, when by remaining in town there was a probability that it might pass off again without any effect." <br /><br />Plus, Smith thought, to take the infection to friends in the country would be unforgivable. Smith only longed for something to do. The ships William Penn and George Barclay had arrived from London only to be warned not to come up because consignees had fled and the customs house was closed. The only business Smith transacted was taking two notes to a bank where, to avoid as much personal contact as possible, he "threw" them at a clerk.<br /><br />Although he cited his missing a visit as reason enough for a patient to die, Rush encouraged people to carry-on without him by liberally using mercurial purges. The fully recovered Margaret Morris treated her maid Sally, who seemed to have a mild case, "as Dr. Rush directs." Then she began vomiting "blackish stuff and the discharge downwards was the same, and then she vomited blood."<br /><br />Morris "began to make experiments." She had Sally lick salt and alum and then quenched the resulting thirst with elixir of vitriol, vinegar and water. Her discharges stopped for 24 hours. Then she started vomiting blood again, "It came out like a teapot." Morris went to her neighbor Rush and got medicine to stop the vomiting, but the bleeding continued and Sally's mouth, tongue and lips were as black as ink. Morris gave her bark, and she recovered. The convalescing Rush told Morris that the spontaneous bleeding cured Sally.<br /><br />While Sally was sick, William, an apprentice who was staying with Margaret, was seized. She started him with purges and one of Rush's apprentices stopped in to bleed a pound of blood out of him in the morning and another pound that night. He seemed weak but better. No sooner were the patients in her own house stabilized than Benjamin Smith reported that his three servants were ill. With medicines in hand Margaret went to Front Street and purged everyone. Then the two Smith children felt ill.<br /><br />Back in Walnut Street neighborhood, Margaret's cousin succumbed to the fever. "Practice had made me bold," Margaret later wrote. She gave her cousin a purging powder, and had her bled. Then the two grandchildren living with her got sick. She had not thought the Smith children truly touched with yellow fever, but she had no doubts about the Morris orphans. She asked Rush how to proportion the medicine to the children and dosed them both. One recovered quickly the other didn't. Then the two blacks she had hired to take care of Sally and William got sick and left. With all the sickness, she wrote, "it seemed as if my heart had died within me." To care for all she decided to spend the days at the Smith house and nights in her own house.<br /><br />Benjamin Smith managed to find doctors to see his ill servants. He too had faith in Rush's methods and the servant with the most obstinate fever was bled to the point where he was "low indeed" and "cold at the extremities" through the night. On Wednesday October 9th a doctor and Margaret Morris both visited in quick succession. The doctor allowed the three servants "restorative medicine." "My mother-in-law, who has had much experience in the disorder,..." Smith wrote to his father, "thinks the crisis is past with both and they will do very well."<br /><br />Of the children only his daughter didn't get well. She "can't be got to take medicine but with difficulty nor then in sufficient quantity but we shall try her again." Benjamin was the calm point in the storm, reporting with scant emotion that he was able to do as much as he commonly did. But his wife Debby was fatigued, a condition that was no longer dismissed lightly. She "has taken some medicine which I think will prevent any bad consequences." Her mother Margaret had come to have a great belief in bleeding. For a day she sent for a bleeder in vain - eight were unable to come. She never was so bold to try herself. Finally one came and Debby was bled.<br /><br />On October 5 Benjamin's father sent down a bundle of dried herbs that he thought might be useful, including "tanzy, wormwood of two sorts, one Italian, cardes, balm, isip, pennyroyal." He recommended chewing the wormwood to prevent infection and told of a Frenchman who feared that his servant had the fever. He "was very earnest in inquiry after cardes benedictus or the blessed thistle." It had been hailed in 1578 as a cure for the plague, and the servant recovered with only a blister and the herb given as a tea. There's no evidence that Benjamin Smith used the herbs. He respected his mother-in-law's respect for Rush's methods, which he knew was borne of her observation of several cases.<br /><br />Historians try to distinguish between home remedies and doctor's medicine, contrasting the good works of matriarchs like Margaret Morris with the insensitive prescriptions of doctors like Rush. Actually Rush worked well with the mothers of the city. Rush was overjoyed when another widow visited him and told how she cured herself with several mercurial purges and by having herself bled seven times in six days. Then Benjamin himself got a fever. He thought it only from fatigue. His mother-in-law urged medicine on him.<br /><br />Margaret Morris had the bitter gratification of seeing proof of her diagnostic skill. Benjamin Smith did have the yellow fever, badly. On the 15th she left Smith with what she thought were favorable symptoms. He and Debby had been "twice bled" and both seemed comfortable. But Benjamin rapidly declined. He died on the afternoon of October 18, "without a sigh or groan - and perfectly sensible." Debby Smith completely collapsed. As Margaret Morris prepared Benjamin for the grave, she had to go to her daughter and try to rally her, and then get the family out of their Front Street house which was so close to where the epidemic started back in August.<br /><br />In the week that followed Debby moaned continually. Margaret had lost her husband when she was 29, but she had been surrounded by friends. She and Debby were surrounded by young children, servants and sick or incapacitated relatives. Margaret could do nothing to console her daughter. As for herself, she found comfort in a Bible prophecy "which seems fulfilling" - Amos 3:8 "...there shall be many dead bodies, in every place they shall cast them forth with silence." "When I look round," she continued in a letter she wrote the 24th, "and see what havoc death has made in our city - the young and vigorous taken away, the old and helpless left, many of them without support - my spirit almost dies within me and I am ready to say 'what wait I for? - my delight is in Thee.'" But 15 people were in her house and she very much the strongest.<br /><br /><br />Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com1tag:blogger.com,1999:blog-1723495615431424809.post-72551567247574200212014-01-22T08:16:00.000-08:002014-01-22T08:16:13.220-08:00A Short History of Yellow Fever in the US<div align="center"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-CHx_Q-jJ-XM/Ur9ym6eN8BI/AAAAAAAAvUE/V4sPWMEeGxA/s1600/archwharf1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-CHx_Q-jJ-XM/Ur9ym6eN8BI/AAAAAAAAvUE/V4sPWMEeGxA/s400/archwharf1.jpg" /></a></div><blockquote><blockquote><blockquote><div align="center"><b>Dr. Benjamin Rush mistakenly traced the origin of the 1793 epidemic in Philadelphia to rotting coffee dumped on the Arch Street wharf</b></div></blockquote></blockquote></blockquote><span style="font-size: medium;">From 1793 to 1822 yellow fever was one of the most dreaded diseases in the port cities of the United States. Statistically, one can dismiss it as inconsequential in comparison to tuberculosis and smallpox. Yellow fever did not kill that many people, but during that period, it struck with such ferocity in principal cities that it spread gloom and fear throughout the country. Doctors were uncertain of the cause of yellow fever and the factors that led it to reach epidemic proportions.&nbsp;</span><br /><br /><span style="font-size: medium;">That uncertainty was not unique. The causes of other diseases were also unknown. But doctors and patients then had an acute understanding of fever. Today, fever is a symptom that can usually be controlled with over-the-counter medicines. Then, fever was tantamount to disease itself.&nbsp;</span><br /><br /><span style="font-size: medium;">Fever was far more than a question of body temperature and discomfort. It was a state in which a person's whole being was reordered. Two hundred years ago it was conceived in much the same way that we conceive of cancers. Just as today, when one discusses cancer, death is assumed to be a likely consequence, then when one discussed fever, death was assumed to be a likely consequence. It was this view of morbidity that made yellow fever so feared simply because in the experience of these people who were so sensitive to fevers, yellow fever was most powerful and horrible.</span><br /><br /><span style="font-size: medium;">Yellow fever was also exotic. Epidemics prior to 1793 all seemed to be exceptions. Philadelphia, for example, had epidemics in 1699, 1741 and 1762. Yet when Dr. Benjamin Rush faced the onslaught of yellow fever in 1793, he could find nothing written on those early epidemics.&nbsp;</span><br /><br /><span style="font-size: medium;">He inspired his old mentor, Dr. John Redman, to write about his experiences in 1762. Rush did have a published monograph on the 1745 epidemic in Charleston, South Carolina, and unpublished letters on a 1741 epidemic in Virginia. So prior to 1793 the country's experience with epidemic fevers was dominated by malaria, then called the intermittent (if mild) or remittent fever (if severe), the many childhood illnesses, scarlet fever perhaps being the most frightening, and smallpox. However, since mid-century, smallpox was thought to be manageable by a regimen of inoculation. That said, extraordinary congregations of people, such as occurred in the massing of troops during the Revolution, did lead to deadly smallpox epidemics.&nbsp;</span><br /><br /><span style="font-size: medium;">Yellow fever was considered a disease of the tropics, and it entered the lives of American families primarily as a scourge claiming the lives of sons and brothers who voyaged to the West Indies, at that time America's principal partners in trade. In the tropical context, where deadly varieties of malaria were far more common, yellow fever was not of special concern.&nbsp;</span><br /><br /><span style="font-size: medium;">One exposure to yellow fever conferred lifetime immunity (a fact not understood at the time) so among the natives and creoles on the islands there was a large pool of immune people. In addition, slaves brought from West Africa likely had exposure to the fever there. In general, children survived the disease better than adults. So in areas where yellow fever could be said to be endemic, many people could not get the disease.</span><br /><br /><span style="font-size: medium;">We know today that yellow fever is a virus spread by the Aedes aegypti mosquito. This mosquito has peculiar habits which we are continuing to learn about. Its most distinguishing feature from other mosquitoes is its preference for urban habitat. It breeds best in relatively clean standing water and outdoor cisterns were a prominent feature among many city houses in that day before indoor plumbing. It also feeds during the day, and so must have quite enjoyed the bustling scenes common at the quays of the major port cities of the 18th century. Finally, it has no trouble adapting to life inside a house or a ship. Thus in a day when window screens were unknown, it had ready access to relatively unprotected environments.</span><br /><br /><span style="font-size: medium;">In the 18th century the epidemiology of yellow fever was a matter of great dispute. But in retrospect we can see how the disease found a foothold in cities like Philadelphia, and why the disease spread with such devastation. The trade with the West Indies provided ships that were essentially small cities, with their cisterns of water, crowded conditions and concealed spaces, plying the seas frequently between the natural tropical habitat of the mosquito and temporary refuges in temperate climes where the pool of immune people was constricted to seamen with experience in the West Indies, those born in Africa, and survivors of the two earlier epidemics in 1741 and 1762.&nbsp;</span><br /><br /><span style="font-size: medium;">Still of some mystery is why, given those condition, yellow fever wasn't a more frequent visitor to American ports. In the current discussion of global warming, many are warning that warmer temperatures will bring tropical diseases like yellow fever and malaria to the north. However, malaria was epidemic in many northern areas, and even endemic in ideal habitat during the 17th century in a period known as the Little Ice Age. Most likely, like many lifeforms, either the Aedes aegypti mosquito or the yellow fever virus or both, have periods of greater virulence dependent on factors still not understood.</span><br /><br /><span style="font-size: medium;">In any case, in early August residents of Philadelphia's Water and Front Streets near the quays began dying of a fever in a matter of days exhibiting uncommon symptoms. (For more on early days of the epidemic see my </span><a href="http://www.blogger.com/ch1.html"><span style="font-size: medium;">Chapter One</span></a><span style="font-size: medium;">.) By the end of August those symptoms which distinguished yellow fever from other fevers had become notorious.</span><br /><br /><span style="font-size: medium;">Perhaps the most insidious was the conviction of the victim that he was getting well. The fever had a remission two to three days after the on-set of symptoms of nausea and general debility which sent some victims back to their jobs and into the streets only to drop dead.&nbsp;</span><br /><br /><span style="font-size: medium;">As the disease matured so did the horror of the symptoms. There could be bleeding at any and every orifice of the body, even through the pores of the skin. Vomit came out black. There could be constant hiccuping so that relatively lucid moments provided no comfort. Not a few fevers course their way through the body seemingly capricious in the pain they inflict. Yellow fever did so with uncommon destructiveness of bodily functions with the embarrassing side effect that the victim could still almost to the end suffer the delusion that he or she was getting better.&nbsp;</span><br /><br /><span style="font-size: medium;">This demeaning of the yellow fever victim was doubly demoralizing because unlike in most infectious diseases the principal victims were not the elderly and children. The first group recognized as prone to get it were males between the ages of 15 and 40. Thus many heads of family were victimized.&nbsp;</span><br /><br /><span style="font-size: medium;">Soon enough, the community realized that the disease was not confined to any one age group or sex. Even an early hope that blacks were exempt was soon dashed. Finally, while most diseases spread in areas of filth among people who are impoverished, the yellow fever mosquito could thrive among the hallmarks of cleanliness -- the full water cistern in back and the spacious houses of the rich.&nbsp;</span><br /><br /><span style="font-size: medium;">Profiling of the victims of yellow fever highlights the power of the disease. Today, social historians commonly use it as a marker of the extent of poverty in cities like Philadelphia, showing that the poor in crowded alleys were its principal victims. At the time, not a few grabbed onto the same statistics with the same, for the rich, hopeful conclusions, but the general gloom about the disease spread because it was clear throughout that no one was exempt. Even Samuel Powel, a former mayor, one of the city's richest men, with access to country homes and personal round the clock attendance of physicians, fell a victim to the fever.&nbsp;</span><br /><br /><span style="font-size: medium;">Benjamin Rush was the first to recognize the disease as yellow fever.</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-QON8DoRWjE8/Ur9zPAOF3TI/AAAAAAAAvUM/nSBct4ymz3g/s1600/rushpor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-QON8DoRWjE8/Ur9zPAOF3TI/AAAAAAAAvUM/nSBct4ymz3g/s400/rushpor.jpg" /></a></div><br /><span style="font-size: medium;">A man of great energy, he took an activist approach to the disease. While this seems a common enough trait in a medical man today, recall that in the 18th century what passed for medical practice was frequently ridiculed. During epidemics, doctors were as prone as preachers to point out that all was in the hands of God.&nbsp;</span><br /><br /><span style="font-size: medium;">From the beginning Rush's activism was challenged. Until the middle of September when upwards of 50 people were dying a day, some doctors continued to deny that there was truly an epidemic of yellow fever. Like all activists Rush was a public man and he was eager to enlist institutions, some that he helped create, in the fight against the disease.&nbsp;</span><br /><br /><span style="font-size: medium;">In late August the College of Physicians issued instructions, written by a committee dominated by Rush, on how to avoid infection -- essentially by moderating all habits, and disinfecting homes with vinegar and camphor, avoiding victims and creating a fever hospital to care for victims. To provide nursing to those abandoned victims, Rush also inspired the city's African Society to provide nurses under the theory that blacks could not get the fever.</span><br /><br /><span style="font-size: medium;">Needless to say the response of many to this was flight from the city. However, most historians over estimate this response. In large part this is because a goodly portion of the primary documents about the fever were written by those who fled (even the principal "instant history" written by Mathew Carey.) Understandably those who fled wanted to paint a bleak picture of the situation they faced in the city and associate their own flight with a widespread and seemingly rational reaction to the situation.</span><br /><br /><span style="font-size: medium;">Compared to later epidemics, the hallmark of the 1793 epidemic, was how many people stayed barricaded in their houses. Business did not continue as usual. Not only was the port quarantined by most of the world, but Philadelphia itself banned incoming ships for fear that they would bring more disease to the city. However, the Wednesday and Saturday markets continued. Banks remained open, and while mail delivery stopped, the post office remained open. Save for the final two weeks of the epidemic, some churches continued to hold Sunday services.&nbsp;</span><br /><br /><span style="font-size: medium;">Thus the varieties of testimony for these virtual captives is startling. There are the almost daily letters of the lonely merchant Thomas Welsh, the almost daily letters of the Quaker merchant and family man Benjamin Smith (see </span><a href="http://www.blogger.com/smith.html"><span style="font-size: medium;">A letter</span></a><span style="font-size: medium;">.), Rush's almost daily letters to his wife (see </span><a href="http://www.blogger.com/Rushone.html"><span style="font-size: medium;">Extract</span></a><span style="font-size: medium;">), the diary of the Lutheran minister (see </span><a href="http://www.blogger.com/helmuth.html"><span style="font-size: medium;">diary</span></a><span style="font-size: medium;">), and the newspapers, one of which published daily except Sunday throughout the epidemic.</span><br /><br /><span style="font-size: medium;">It is often written that all the functions of government ceased, highlighted by the flight of President Washington. Actually Washington left on a scheduled vacation at the scheduled time September 10, some days after neighbors and even a cabinet member, Alexander Hamilton, had taken the disease. And he had a job to do: officiate at the laying of the cornerstone of the Capitol building in the City of Washington. (<a href="http://fevercasebook.blogspot.com/2012/01/george-washington-and-yellow-fever.html" target="_blank">http://fevercasebook.blogspot.com/2012/01/george-washington-and-yellow-fever.html</a>&nbsp;&nbsp; )</span><br /><br /><span style="font-size: medium;">Of course, the federal government was relatively small then and its functions, save for mail delivery, had little to do with daily city life. Those government clerks in the Treasury who did carry on necessary work for the nation's commercial life did work in their offices during the epidemic (and letters from some of them remain.) Their bosses did leave but obviously policy decisions were not going to be made during the epidemic.&nbsp;</span><br /><br /><span style="font-size: medium;">The state government began the epidemic in full force, with the legislature in session. However, they promptly adjourned after giving the governor more power to enforce quarantines on incoming ships. The governor soon left the city, but not before doing all he could to enforce a clean-up of the city. In his earliest pronouncements Rush blamed rotting coffee on one of the wharves as the spark that set off the epidemic.</span><br /><br /><span style="font-size: medium;">That left Mayor Matthew Clarkson and he did not abandon the city. He correctly perceived that the challenge was to find those who needed help and provide food for those who remained. Usually the volunteer Overseers of the Poor guided the city in these functions, sending the poor who were sick to the public dispensary and alerting other charities to their other needs.&nbsp;</span><br /><br /><br /><span style="font-size: medium;">The ranks of the overseers were depleted by flights from the city, so Clarkson organized a public meeting to raise volunteers. In a matter of days, a system was set up in which the dead and dying were identified by volunteers going door to door if needs be.&nbsp;</span><br /><br /><span style="font-size: medium;">The sick were taken to the fever hospital set up in a temporarily abandoned estate called Bush Hill (last rented by Vice President John Adams then far away in Massachusetts.) A French merchant named Stephen Girard, who would in time become one of the richest men in America, administered the hospital with personal attention that inspired the city.</span><br /><br /><span style="font-size: medium;">At first young American doctors treated the sick at the hospital, but soon a French doctor, Jean Deveze, a recent refugees from the black revolt in what would become Haiti, took over. Working in Haiti, he was no stranger to treating yellow fever. (see </span><a href="http://fevercasebook.blogspot.com/2011/04/dr-devezes-bush-hill-cases.html" target="_blank">http://fevercasebook.blogspot.com/2011/04/dr-devezes-bush-hill-cases.html</a><span style="font-size: medium;">)&nbsp;</span><br /><br /><span style="font-size: medium;">The African Society provided men to cart the victims either to the graveyards or Bush Hill. Clarkson also saw to it that several bakers received enough flour to bake bread for any and all.</span><br /><br /><span style="font-size: medium;">By the third week in September a new reality took hold in the city that lasted until the third week of October. It featured quiet streets punctuated by the rumble of the cartmen, save for when the markets were briefly open or the mail was distributed at the post office. Others delivering messages between suffering families also ventured out, as did boys delivering newspapers, and those not few citizens who thought themselves out of danger.&nbsp;</span><br /><br /><span style="font-size: medium;">The other great exception was the Quaker's Yearly Meeting. They decided not to doubt the wisdom of God by postponing the meeting due to an epidemic that was itself a visitation from God. So delegates from around the nation and city came to the meeting house in the heart of the epidemic.&nbsp;</span><br /><br /><span style="font-size: medium;">And then there were the doctors. While we look upon the medical practices of the late 18th century as only marginally better than that of the Middle Ages, there was a belief at the time that, as in all things during that Age of Enlightenment, rational inquiry was making medicine better and that rapid advances were in store.&nbsp; Some like Rush could combine Enlightenment rationalism with religious Millennial conceit and think that advances in medicine in part heralded the second coming of Christ.&nbsp;</span><br /><br /><span style="font-size: medium;">Within two weeks of the public recognition of the severity of the epidemic (which was about August 25), four doctors offered public explanations of the disease and its treatment (</span><a href="http://www.blogger.com/kuhn.html"><span style="font-size: medium;">Items</span></a><span style="font-size: medium;">.) Among the four were perhaps the two most prominent doctors in the city, Rush and Adam Kuhn.&nbsp;</span><br /><br /><span style="font-size: medium;">All the doctors disagreed and soon the controversy between them became disagreeable. In a nut shell, traditional practice at the time dictated that a debilitating disease like yellow fever should be treated with stimulants including wine, "bark" which was a liquid distilled from the bark of a Peruvian tree, and cold baths. Rush advocated a different approach. He thought the debility of the fever in itself a deadly stimulus to the body and that it best be counterintuitively fought with heroic depleting remedies, primarily calomel purges and copious bleeding with the lancet (leeches were not popular in Philadelphia then and would be far too slow for Rush's purposes.)&nbsp;</span><br /><br /><span style="font-size: medium;">Most historians favor the former treatment. While ineffective it did not make the patient any worse off. However, I feel that Rush accurately identified the drama being played out. Yellow fever does kill by the shock it administers to the system so why not weaken the patient and prevent the body from over-reacting to the stimulus of the disease?&nbsp;</span><br /><br /><span style="font-size: medium;">Most doctors and many patients were won over to Rush's basic approach. Recall that many of the victims were in their prime of life, one did not react to a violent mortal disease by sipping tea. Soon some purging and bleeding became commonplace. Even doctors who historians hail as gentle practitioners, like Deveze, did bleed, and resorted to blisters on the neck and head (which required shaving the head) and hot bricks placed on the extremities to try to revive dying patients.</span><br /><br /><span style="font-size: medium;">Rush also accurately identified the varieties and stages of yellow fever. In some victims the virus has little effect; others have disturbing symptoms that last only a few days; and others either get the fever in full force immediately and die almost as if poisoned or have a horrible relapse on the third or fourth day of the fever and are often dead a few days later.&nbsp;</span><br /><br /><span style="font-size: medium;">From society's experience with smallpox, it was common in that day to prepare the body for disease. In the process of inoculation, patients were isolated, purged and put on a special diet, and then exposed to smallpox in hopes that they would, under constant care, have the disease lightly and then remain immune to it for the rest of their lives. Using the same thinking, Rush urged people to take purges and be bled at the slightest onset of illness.&nbsp;</span><br /><br /><span style="font-size: medium;">It was this, usually, self medication of strong purges that alarmed other doctors. Estimates of the number of dead during this epidemic range from 3,000 to 5,000. The official total was 3,881. Very few were observed by doctors and there were no scientific accounts of their manner of dying. There were a few autopsies which illuminated the obvious, the stomach was quite overwhelmed.&nbsp;</span><br /><br /><span style="font-size: medium;">However, two observations grabbed hold of the city's imagination. The first was that the appearance of black vomit invariably meant the patient would die. The second was that patients who evidenced ptyalism or the constant drooling of saliva in the mouth after taking mercury compounds all recovered. This ptyalism was caused by what we now call mercury poisoning.&nbsp;</span><br /><br /><span style="font-size: medium;">Mineral mercury (we can now identify organic mercury compounds) is the primary ingredient of calomel, a medicine first developed in the 16th century. In 1793 it was not considered a poison and when oral doses didn't bring on salivation, doctors rubbed mercury ointments on the patient's gums. The name "calomel" refers to its sweet, honey-like taste, that made it much easier to swallow than the usual fever remedy, bark, which was rather bitter.</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">Thus the typical yellow fever patient was confronted with a frightening fever of uncharacteristic violence and, by many of city's doctors and newspapers, encouraged to take violent remedies that cause vomiting and severe diarrhea combined with continuous bleeding which could lead to an at least groggy if not comatose state.</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">But bear in mind that it was often not the patient who decided what remedies would be tried but those family members watching them. The depleting remedies favored by Rush at least had the advantage for family members of making the yellow fever victim manageable, not liable to run out in the streets in the throes of delirium.</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">That said, Rush also broadcast his remedies as preventatives urging that people feeling any premonitions of fever take calomel and get bled. In the modern context when preventatives rarely debilitate and are design to strengthen the body, Rush's campaign seems in retrospect to have been absurd. But Philadelphia was confronted with an epidemic killing a little over a hundred people day despite several thousand people leaving the city. To many strong measures seemed in order.</span><br /><br /><span style="font-size: medium;">Rush jumped to the conclusion that not only those who took his remedies and did not die were cured by his remedies but also those who took his remedies as preventatives and who did not get the disease were cured by his remedies. Thus he claimed that of 100 people who took his remedies only one died.</span><br /><br /><span style="font-size: medium;">Compared to medicine today, medicine then did not show the circumspection that is the hallmark of a generally successful profession. Medicine then had few success stories. Inoculation for the prevention of small pox was perhaps the foremost and to effect that patients had to undergo a considerable ordeal as they were infected with a minimized exposure to matter from small pox postules while being treated with medicines, often calomel, while under a doctor's supervision and usual in a group of patients. The hope was that they would have a mild case of small pox that would assure lifetime immunity from the disease.&nbsp; </span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">Meanwhile, Dr. Deveze did manage patients at the Bush Hill hospital which took an approach that seems more reasonable to us. In anticipation of the possible violent symptoms the fever might exhibit, a patient did not have to be treated with violent remedies. Deveze treated symptoms as they arose. However,&nbsp; there is no evidence that this increased the chances of survival. Deveze criticized Rush's purges for so deranging many patients' stomachs that nothing could be done to save them.</span><br /><br /><span style="font-size: medium;">In speculating on this competition between doctors, it should be remembered that, because of the crisis, getting to either Rush or Deveze or their many disciples was problematic. Sickness kept Rush in bed for a couple weeks and Deveze was out of town. A family had to summon the courage to send a loved one by cart to the hospital in a context which was unfamiliar to them. In the experience of the city, hospitals provided care for those with long term conditions, especially insanity. The yellow fever hospital was being invented as the epidemic progressed and it closed when the fever ended.</span><br /><br /><span style="font-size: medium;">Most of the victims of the fever in Philadelphia suffered beyond the help of the doctors.</span><br /><span style="font-size: medium;"><br /></span><span style="font-size: medium;">Successive frosts in mid-October began decreasing the incidence of new fever cases. By early November the epidemic was over. People returned to the city and business resumed, ships finally coming up river and merchants displayed their fall goods. After some initial doubts, the federal government returned and Congress resumed its session on schedule in December after a recess of several months. The volunteers who held the city together were hailed as heroes, save for the blacks who were unjustly accused of profiting from the epidemic either through pilfering abandoned houses or charging exorbitant sums for nursing victims. (To read a defense of the African American nurses go to </span><a href="http://www.blogger.com/allen.html"><span style="font-size: medium;">Richard Allen's Memoir of the 1793 Epidemic.)</span></a><span style="font-size: medium;">&nbsp;</span><br /><br /><span style="font-size: medium;">The sacrifice of the doctors, several died, was also noted, as well as the work of the preachers who remained. However, the sacrifice of the doctors and preachers soon became problematical because for both groups the epidemic's end was the beginning of a new campaign. The preachers led a campaign of moral reform highlighted by a failed effort to get the state legislature to ban theatrical entertainments. The doctors engaged in a heated controversy about the origin of the disease. Rush argued that the seeds of yellow fever were engendered by the filth of the city.&nbsp;</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-M7Up5grTaWc/Ur9z2KZDVuI/AAAAAAAAvUU/wTU85CLMzzo/s1600/rushfever.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-M7Up5grTaWc/Ur9z2KZDVuI/AAAAAAAAvUU/wTU85CLMzzo/s400/rushfever.jpg" /></a></div><br /><span style="font-size: medium;">His opponents, and there were many, argued that the seeds of the disease came from the West Indies. The governor embraced both ideas calling for greater civic cleanliness and stricter quarantines and inspection of incoming vessels.&nbsp;</span><br /><br /><span style="font-size: medium;">From our vantage point, these debates were moot, all suffering from any inkling of how the disease was spread. If yellow fever retreated for another 30 or 40 years, as it seemed to be in the pattern of doing, the debates would have soon ended. However, yellow fever returned.&nbsp;</span><br /><br /><span style="font-size: medium;">During the 1793 epidemic it became clear to many that an epidemic in New York City in 1791 was yellow fever. The city establishment had suppressed almost all discussion about the epidemic. In 1793 New York as well as most other cities in the nation instituted strong quarantines against people fleeing from Philadelphia, turning them away a gunpoint in some places (see </span><a href="http://www.blogger.com/nyc93.html"><span style="color: black; font-size: medium;">New York City's 1793 Campaign</span></a><span style="font-size: medium;">.) Baltimore had one of the strictest quarantines. And not without gratification to some in Philadelphia, in 1794 Baltimore was struck with an epidemic. (See the </span><a href="http://www.blogger.com/balto1794.html"><span style="font-size: medium;">1794 epidemic in Baltimore, Maryland.</span></a><span style="font-size: medium;">)&nbsp;</span><br /><br /><span style="font-size: medium;">City officials tried to keep news of the epidemic out of the newspaper or "spin" it as just a common fever, but other cities quarantined Baltimore, and a young student of Rush's sent out letters describing all the characteristic symptoms of yellow fever. His memoir of the epidemic provides one of the best collection of case studies of yellow fever victims at that period. At the same time, New Haven, Connecticut, had an epidemic. (See the </span><a href="http://www.blogger.com/newhaven.html"><span style="font-size: medium;">1794 epidemic in New Haven, Connecticut.</span></a><span style="font-size: medium;">) Around 200 people died in Baltimore and 64 in New Haven but the nation was served notice that the great epidemic of 1793 might not be a quirk.&nbsp;</span><br /><br /><span style="font-size: medium;">Indeed Rush discovered a few cases of suspected yellow fever in Philadelphia and used them to write another memoir about yellow fever, outlining more ideas about preventatives and cures. For the latter he placed even more emphasis on frequent and copious bleeding, and to prevent the fever listed many vegetables whose putrefaction could engendered disease. He arrived at this not by experimentation but by a search of the medical literature dating back to the Ancient Romans. He also encouraged a system of quarantine and enforced clean-ups on a block by block basis when yellow fever struck.&nbsp;</span><br /><br /><span style="font-size: medium;">In a sense the public health history of the 1790s became a case of public authorities finally grasping the lurid reality that Rush and others began painting for them. From our perspective the epidemics seem rather limited episodes both in time and space. But epidemic is a tricky word. We use it now in a time and place where we are largely exempt from common every day infectious diseases more serious than the common cold. In the 18th century calling a disease epidemic was only a way of distinguishing something relatively uncommon from the daily incidence of often deadly infectious diseases.&nbsp;</span><br /><br /><span style="font-size: medium;">Noah Webster noted an influenza epidemic in 1793 and in part through his efforts, the country's first medical and scientific magazine, The Medical Repository, began publishing and its major focus was on fever epidemics around the country. In an earlier publication Webster collected essays on fevers in New York, New Haven and rural Massachusetts. Webster began embracing the Classical notion that epidemics were caused by "the epidemic constitution of the atmosphere," which Webster soon postulated could maintain the current state of national ill health for another fifty years.</span><br /><br /><span style="font-size: medium;">The nation did not have long to wait before the lurid reality of a major yellow fever epidemic returned. But setting the scene for that were two mild epidemics, the first in New York City in 1795 that killed about 730</span><span style="font-size: large;"><b></b></span><span style="font-size: medium;">(see </span><a href="http://www.blogger.com/NY1795.html"><span style="font-size: medium;">NY1795</span></a><span style="font-size: medium;">)</span><span style="font-size: large;"><b></b></span><span style="font-size: medium;">and the second in Philadelphia in 1797 that killed 1100 (see </span><a href="http://www.blogger.com/ch12.html"><span style="font-size: medium;">Chapter Twelve</span></a><span style="font-size: medium;">.) Those death tolls are startling enough, but the victims were confined to certain sections of the city. New York actually boasted that most of its victims were strangers and people of little account -- don't be fooled by the minister who died, he was just a Methodist!&nbsp;</span><br /><br /><span style="font-size: medium;">In Philadelphia a system of block by block quarantines with cleanups was tried with mixed success. Many residents and even doctors balked at reporting cases of the disease for fear of patients being taken away and denied access to their homes. Yet, the 1797 epidemic seemed to many to have been well managed and many felt that the city could deal with an epidemic without the citizens abandoning the city.</span><br /><br /><span style="font-size: medium;">By all accounts the late summer and fall of 1798 was an almost incredible time in American history. Perhaps because of that historians have largely forgotten it, even the historians of the cities that were ravaged by the epidemic. Philadelphia, New York, Boston and many smaller ports in between, had yellow fever epidemics (see : </span><a href="http://www.blogger.com/1798.html"><span style="font-size: medium;">1798.html</span></a><span style="font-size: medium;">.) At the time the total death toll was estimated by some observers at 10,000. The official numbers are just a little over half that, with some 3,500 in Philadelphia, 1,500 in New York.&nbsp;</span><br /><br /><span style="font-size: medium;">Because of their experience with their last epidemic, city officials in both Philadelphia and New York first reacted to the epidemic with some degree of confidence. However, the fever spread so rapidly in Philadelphia that by early September officials gave up any hope of containing the epidemic. They channeled their efforts into setting up camps in the countryside and inviting those without other places of refuge to go there.&nbsp;</span><br /><br /><span style="font-size: medium;">New York officials stubbornly adhered to the notion that the fever was centered in only certain areas of the city, and even in those areas, rather than evacuate people, the city established soup kitchens to lessen the disruption caused by the growing number of deaths. In retrospect the health committee decided that was a mistake. The only bright side to these epidemics was that early frosts brought them to an early end.</span><br /><br /><span style="font-size: medium;">As it turned these were the last major yellow fever epidemics in these northeastern ports. However, the fear of epidemics remained. More families left the city during the late summer as a matter of practice and at the first sign of an epidemic, evacuation was widespread. A larger portion of people left Philadelphia during the small epidemics of 1799 (see </span><a href="http://www.blogger.com/acct99.html"><span style="color: black; font-size: medium;">Rush's Account of the Philadelphia Epidemic of 1799</span></a><span style="color: black; font-size: medium;">) </span><span style="font-size: medium;">and 1802 than did in 1793. New York's last epidemic of note in this period was in 1805.&nbsp;</span><br /><br /><span style="font-size: medium;">Needless to say both these major cities continued to try to prevent the recurrence of the epidemic. Even the federal government became involved. The first order of business President John Adams mentioned in his 1798 annual message was the possible need for stricter quarantines enforced nationwide. Civic leaders in Philadelphia proposed a three pronged attack: cessation of trade with the West Indies during the summer months, a municipal water system to bring "pure" water in the city, and a redoubled effort to clean privies, and disinfect the houses of the poor. New Yorkers also embraced the idea of an improved water system.&nbsp;</span><br /><br /><span style="font-size: medium;">Very little work has been done by historians on the social effects of the epidemics. Did they contribute to the religious revival called the Second Great Awakening? Did they contribute to disillusionment with the Federalist Party? Certainly the epidemics defeated the plan of Philadelphia officials to try to persuade the federal government not to move to the new city of Washington. And the state capital soon moved to Lancaster. In 1798 the Quaker's once again had their Yearly Meeting during the height of the epidemic but the death toll among their society became too great and they rescheduled their Yearly Meeting for April, and have met then ever since.</span><br /><br /><span style="font-size: medium;">However the effects of the epidemics on medicine are clearer. The fear of any fever became such (and doctors like Rush suggested that any fever given the right local conditions could develop into yellow fever,) that heroic depleting remedies, especially bleeding, became increasingly popular. That in turn fostered alternative medicine highlighting herbal remedies and in the case of homeopathy minimal doses of medicine.</span><br /><br /><span style="font-size: medium;">An unfortunate result was that at this time when medical concerns came to the forefront as never before, medicine offered the wrong answers and dangerous remedies. In the later epidemics some of the most prominent victims were doctors and newspaper editors. Both groups sacrificed themselves to stay on the front lines of the epidemics, an essential service for the nation only, tragically, to supply misinformation.</span><br /><br /><span style="font-size: medium;">Yellow fever returned for a brief encore in northern cities in 1822. After that it confined itself to southern ports and river cities. Portsmouth, Virginia, on one end of this arc and New Orleans on the other had the deadliest single epidemics. In the 1878 a devastating epidemic ravaged the Mississippi Valley as far north as Memphis. However, in general after 1820 the profile of the fevers suffered by the nation began to change. In New England even the prevalence of intermittent fevers (malaria) was soon forgotten. By the 1830s Baltimore had far fewer of what we know now were mosquito borne diseases. (However, the upper Mississippi Valley remained a hotbed of malaria, as well, of course, as the South.)&nbsp;</span><br /><br /><span style="font-size: medium;">Not that northern cities necessarily became healthy. Cholera became the feared deadly epidemic. Other diseases like dysentery and typhoid arising from poor hygiene and over crowding became more commonplace. However, while these diseases could kill any age, they generally culled the old and young.</span><br /><br /><span style="font-size: medium;">So in many respects the yellow fever epidemics stand as unique crises, striking the capital and major cities of a rather proud new nation, and striking the strong and powerful as well as the poor. That in part explains why they were not memorialized then and are scarcely studied today. There is always a certain degree of denial mixed into any country's history. Certainly today we tend to analyze the birth of the Bill of Rights to death, while ignoring the bills of mortality in the 1790s. And then those social historians who do study those bills of mortality find in yellow fever a chimerical subject for study, and prefer the endemic killers which produce valid statistics.&nbsp;</span><br /><br /><span style="font-size: medium;">Yet it bears remembering in the colorful and delicious days of early fall when the landscape is relieved of any hint of the tropics, that in the 1790s many cowered in their houses fearful of black vomit and blood coming out of their ears, while a tiny mosquito, quite out of its element, romped in a brief orgy of blood and death. </span>Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com1tag:blogger.com,1999:blog-1723495615431424809.post-50192857387593126342012-03-30T20:21:00.001-07:002012-03-30T20:21:23.721-07:00Caspar Wistar﻿<br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-WN_opzLT5rA/T3Z2tdxdvwI/AAAAAAAAieY/l7U8aV02YwA/s1600/wistar.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-WN_opzLT5rA/T3Z2tdxdvwI/AAAAAAAAieY/l7U8aV02YwA/s1600/wistar.jpg" /></a></div><br />In early September when Dr. Benjamin Rush first tried drastic purges on patients, he invited Dr. Caspar Wistar to observe their affects on the wife of Captain Bethel, a ship's chandler on North Front Street. She was Rush's mother's step-daughter from her last marriage. She was experiencing the restlessness characteristic of the early stages of the fever. Rush told her to "drink copiously of chicken water," i.e. a very weak broth, and lie in her bed. Then he gave her a pill that combined 10 grains of calomel with 15 grains of rhubarb. She took the first dose, and the two doctors did not have long to wait for a reaction. She vomited "a large quantity of bile."<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-yyIiT1Zqvk8/T3HfZDHloFI/AAAAAAAAh-A/LAJzWBS9WYA/s1600/lc_calomelcamphor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="198" src="http://3.bp.blogspot.com/-yyIiT1Zqvk8/T3HfZDHloFI/AAAAAAAAh-A/LAJzWBS9WYA/s320/lc_calomelcamphor.jpg" width="320" /></a></div><br />Wistar was taken aback by the violence of the reaction, and asked, "whether it gave relief as an emetic or cathartic?" That is, was it intended to induce vomiting or purge the intestines and bowels. Rush answered that while the target was not the stomach, but the seat of putrefaction below, the puking was a good sign showing that the medicine provided "more speedy service." Wistar argued that if relief came from vomiting, a medicine with less bothersome side effects could have been used. Rush ended the discussion by giving Mrs. Bethel another dose. Wistar thought Mrs. Bethel looked "very unwell." Rush later told Wistar that he waited until the pill brought on a copious purge followed by a sweat, and Mrs. Bethel recovered.<br /><br />Wistar soon found it more difficult to see patients. He had constant headaches. Then he could no longer stand the light of the sun. He diagnosed his own case: he had yellow fever. He had taken preventatives, including bark every morning and evening,<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-OYeWtlR7Kwk/T3Zzh5O-0QI/AAAAAAAAid0/nQFJPPZ7348/s1600/bark.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="154" src="http://2.bp.blogspot.com/-OYeWtlR7Kwk/T3Zzh5O-0QI/AAAAAAAAid0/nQFJPPZ7348/s400/bark.jpg" width="223" /></a></div><br />and followed all the rules save one - he swallowed his spittle while in a sick room. Because of that Wistar thought he got the fever. Two days after he saw Rush treat Mrs. Bethel, he had "a smart fever and delirium." By a messenger Rush ordered him to take calomel, but he didn't. He had his apprentice fetch ipecac, which worked several times.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-oHbU8aujpvA/T3Z0gfT2T2I/AAAAAAAAieI/i12lXFoaUaM/s1600/ipecac.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="http://4.bp.blogspot.com/-oHbU8aujpvA/T3Z0gfT2T2I/AAAAAAAAieI/i12lXFoaUaM/s400/ipecac.jpg" width="400" /></a></div><br />His stomach still felt heavy and sore. Then Rush came to him and did not consult. He insisted that Wistar take calomel and jalap. He did and when he was able, Wistar sent word that the purge operated and relieved him, but he didn't tell Rush that his fever returned sharply and he felt miserable.<br /><br />When Wistar recovered, Rush counted it a major victory for mercurial purges. He tried to elicit a testimonial for his cure. For the moment Wistar kept to himself what remedies he thought most beneficial. He appreciated the power of calomel, but as he recovered from a delirium he became conscious of a wonderful cold wind from a window left open in his room. He instructed his students to keep him cool. When the breeze from the window was too hot, the young men took turns fanning their master. To that, Wistar attributed his recovery.<br /><br />A few weeks later Wistar described his illness and treatment in a letter published in a newspaper. After describing his consultations with Rush early in his illness, and how calomel and jalap relieved him, Wistar said he was not sure if mercurials or milder saline cathartics were better. That said, he endorsed cold air as the best remedy. Having the window open had revived him far more than any medicine. Wistar also acknowledged Dr. Kuhn for stopping his diarrhea with laudanum, and prescribing a "tincture amara" which, after sipping for every two hours for 24 hours, allowed Wistar to "eat rice and chocolate without suffering."<br /><br />After reading that Rush threw down the paper, and quoted Shakespeare's Julius Caesar: "This was the most unkindly cut of all...." Wistar was his Brutus. He lashed out at Wistar in his morning letter to his wife. Wistar's letter was "certainly calculated to injure me and to create doubts as to the efficacy of the new remedies."<br /><br />He wrote a short letter to the newspaper chiding Wistar. If he had taken calomel as Rush had prescribed it, he would have recovered quickly and been back at work, "uniting at the same time, his testimony, with that of thousands of his fellow citizens, in favor of that excellent remedy." <br />Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com2tag:blogger.com,1999:blog-1723495615431424809.post-85865116299359291522012-01-20T18:48:00.000-08:002012-01-23T18:12:13.223-08:00George Washington and Yellow Fever<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/-dFiKxOXNCNo/TauUykVLK5I/AAAAAAAAZPw/UrN8oEcDUCs/s1600/preshouse.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 286px;" src="http://3.bp.blogspot.com/-dFiKxOXNCNo/TauUykVLK5I/AAAAAAAAZPw/UrN8oEcDUCs/s400/preshouse.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596730558404832146" /></a><br /><br />In 1793 there were neither policies nor precedents about how the federal government should react to a deadly epidemic in the nation's capital. Government officials and employees did not work in offices set apart from the rest of the city. The President lived in a rented mansion flanked on one side by a shady garden, but he had neighbors though it was in a more thinly built part of the city. In the first week of September one of his neighbors, Dr. Caspar Wistar, was sick with yellow fever.<br /><br />Well before the epidemic, George Washington planned to leave the city. High Federal officials generally left the capital in September. Congress was not in session and it was a good chance to relax before Congress assembled in November or December. In 1793 Washington was expected to attend the ceremonial laying of the cornerstone of the new Capitol building in the new City of Washington, scheduled for September 17. The painting below, done in the 1790s, arranged Washington's family around the plan for the new capital city and captured the President's interest in the city that would bear his name.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-EiKG_iSlQ1A/TbcfoSPVXwI/AAAAAAAAZbU/vv6O5rpMsvk/s1600/GWfamily.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 304px;" src="http://4.bp.blogspot.com/-EiKG_iSlQ1A/TbcfoSPVXwI/AAAAAAAAZbU/vv6O5rpMsvk/s400/GWfamily.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5599979438609882882" /></a><br /><br />Treasury Secretary of Alexander Hamilton was unable to attend a cabinet meeting on September 6, sending word that both he and his wife had yellow fever. The death of Dr. Hutchinson on September 7, while good news for the President as the doctor was a leader of the opposition party that had been personally attacking the President, his death undoubtedly colored the President's view of the health of the city.<br /><br />On September 9, on the eve of his scheduled departure, the President wrote to Secretary of War Knox about a rumor about French intentions, adding:<br /><br /><span style="font-style:italic;">I think it would not be prudent either for you or the Clerks in your Office, or the Office itself to be too much exposed to the malignant fever, which by well authenticated report, is spreading through the City; The means to avoid it your own judgment under existing circumstances must dictate.<br />(<a href="http://memory.loc.gov/cgi-bin/query/r?ammem/mgw:@field%28DOCID+@lit%28gw330087%29%29"> Washington to Knox </a>)</span><br /><br />It is a fair interpretation of this letter to suggest that Washington was anxious to leave and thought the best policy for the Federal government to follow was for all unessential employees to leave the city. At that time the Federal government had no means to respond to the epidemic. It did not employ any doctors, nurses, or anyone else in or near Philadelphia who could respond in an official capacity to the epidemic. There were no soldiers stationed in the city, nor was there a Federal police force of any kind. <br /><br />Washington left the city with his wife, family and servants on September 10. In a September 25 letter to his secretary Tobias Lear, written from Mount Vernon, he described what he was thinking when he left: <br /><br /><span style="font-style:italic;">We remained in Philadelphia until the 10th. instr. It was my wish to have continued there longer; but as Mrs. Washington was unwilling to leave me surrounded by the malignant fever wch. prevailed, I could not think of hazarding her and the Children any longer by my continuance in the City the house in which we lived being, in a manner blocaded, by the disorder and was becoming every day more and more fatal; I therefore came off with them on the above day and arrived at this place the 14th. without encountering the least accident on the Road. (<a href="http://memory.loc.gov/cgi-bin/query/r?ammem/mgw:@field%28DOCID+@lit%28gw330106%29%29"> Washington to Lear </a>)</span><br /><br />One could argue that on the 25th the President had put the onus for leaving on his wife, and that personally he wished to stay, mindful of the affect that might have on the morale of the afflicted city. That is a far cry from the sense of foreboding expressed in his September 9 letter which authorized the flight of Federal employees.<br /><br />In writing a history of the epidemic, it is easy to forget the novelty of the situation and how that forced those living through the epidemic to not act as consistently as a historian might wish. Two things may have happened to change Washington's attitude between the 9th and 10th. Both Secretary Hamilton and Dr. Wistar responded to treatment and were thought to be out of danger. And Samuel Powel, a former mayor of city, declined Washington's invitation for his wife and he to accompany the Washington's to Mount Vernon.<br /><br />Powel's wife expressed their regrets, writing to the Washington's that her husband thought he "thought there was no propriety in the citizens fleeing from the one spot where doctors were conversant with the treatment of the fever...." Powell died of the fever a little over two weeks latter. <a href="http://fevercasebook.blogspot.com/2011/04/samuel-powel.html">Powel</a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/--0mEltFwEo0/TbCN5XkJ2II/AAAAAAAAZQo/Qu-E-Mwjl7U/s1600/mrspowel.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 281px; height: 344px;" src="http://1.bp.blogspot.com/--0mEltFwEo0/TbCN5XkJ2II/AAAAAAAAZQo/Qu-E-Mwjl7U/s400/mrspowel.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5598130353539242114" /></a> <br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/-d6wLw73SLCM/TauTt3zBnOI/AAAAAAAAZPo/Kfa5lLs2Yf4/s1600/powel.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 215px;" src="http://2.bp.blogspot.com/-d6wLw73SLCM/TauTt3zBnOI/AAAAAAAAZPo/Kfa5lLs2Yf4/s400/powel.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596729378219334882" /></a><br /><br />This version might be viewed as bending over backwards to burnish the image of the President, but his actions at the end of the epidemic suggest that he was indeed more mindful of the city's morale than his own safety. <br /><br />In a letter to the President, ﻿Speaker of the House John Trumbull of Connecticut worried that the city would still be unsafe when Congress was scheduled to convene in December. Washington quizzed his advisers on his power to convene Congress in another place. He asked two officers still in or near the city if the suburb of Germantown was safe and if all the terrible things he had heard were true, that many "of our acquaintances have fallen victims...; that near 4000 have died, and that the disorder rages more violently than ever." <br /><br />His advisers split on whether he had the power to convene Congress elsewhere. Jefferson and Madison worried that removal might jeopardize the compromise that<br />moved Congress from New York to Philadelphia in 1790 and would move it to the banks of the Potomac River in 1800.<br /> <br />As for the state of the city, Postmaster General Pickering had been going every day to Walnut Street to encourage the bedridden Dr. Rush, an act of courage given that no less an authority than Rush was certain that his house was the most infected place in the city. Pickering noticed that unlike the week before, Rush's house was no longer "thronged with applicants for assistance." Rush's two remaining apprentices, Coxe and Fisher had been joined by an old student James Woodhouse, and they continued giving out medicines and making visits for Rush. They agreed that on the 12th and 13th of October the number of applicants had "sensibly lessened." Pickering dashed off a note to the president with the encouraging news. And Germantown had to be safe. Governor Mifflin was still there. <br /><br />Washington decided that, while it was still unsafe to return to Philadelphia, he could go to Germantown. He told his cabinet to rendezvous with him there on November 1.<br /><br />Sickness in Philadelphia seemed to decline through October, then there was a sudden spike in cases, and a feeling of gloom returned. His cabinet advised caution. Attorney General Randolph warning that "we have not yet learned, that any radical precautions have commenced for purging the houses and furniture." <br /><br />No matter. ﻿President Washington made a day trip to the city on the 11th, a day before the all clear.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-91400355794143690352011-05-16T13:27:00.000-07:002011-05-16T19:29:29.582-07:00Thomas Fisher﻿As the 1798 yellow fever epidemic spread in Philadelphia, the risks of remaining in business increasingly became apparent. A clerk in Captain Yard's store died on August 15th. A ship broker died on the 20th. By the end of the month the porter at the Bank of the United States was dead; the teller of the Bank of Pennsylvania was sick, the second teller dead. Two clerks at the Bank of the United States were missing.<br /> <br />The flight from the city in early August had been panic. Now most families had poignant stories to tell, too often about the deaths of promising young men and innocent boys. During previous epidemics Quakers had noted that members of their society seemed to be the last afflicted. This year they received an early lesson that one could not flee too soon. Miers Fisher removed his family on the 8th, but stayed himself until the 13th arranging the affairs of his store. His eldest son Thomas, 22 years old, also stayed preparing for a trip north. The young man had survived Baltimore's yellow fever scares, and showed his disdain for the current alarm by not being ready to leave when his father called with a carriage. After waiting two hours, the father drove off after Thomas promised to go out to an uncle's house that night. He reached his uncle's but was ill with a bad headache.<br /> <br />In '93 Miers had been cured by gentle French methods, and until a doctor could be found he treated his son in that manner while clinging to the hope that Thomas was having one of his usual headaches. Then Thomas had a fever. A local doctor recommended cold air and bleeding. Sixteen ounces were taken immediately and then again the next day. Thomas said he felt better but not relieved. Dr. Proudfit from the city came out and thought his case serious. He ordered blisters, and mercury internally with opium and externally to "procure a salivation."<br /><br />Miers, who had been with Thomas constantly for three days, found a black nurse so he<br />could get some rest. The doctors came again at 6 a.m. on the 18th. The local doctor thought Thomas looked better, but not Proudfit. He ordered blisters of mercury, mercury rubs as much as the patient could take and mercury pills, at least one every two hours. Shortly after the doctors left, the father saw a spot on the bed which he suspected was black vomit. His son vomited up the next pill, throwing some of it upon his father. The father began preparing for his son's death. The doctors came again in the evening and thought there was no hope. Thomas died at five the next morning.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-32081919496392839392011-05-03T13:08:00.000-07:002011-05-03T20:53:11.764-07:00The Ship Deborah﻿<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-r4XMSxnnvpY/TcBkerz8wdI/AAAAAAAAZmw/42J3KAWQNpc/s1600/kensington.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 357px;" src="http://1.bp.blogspot.com/-r4XMSxnnvpY/TcBkerz8wdI/AAAAAAAAZmw/42J3KAWQNpc/s400/kensington.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5602588414768366034" /></a><br /><br />On July 8 the ship Deborah from Jeremie, Haiti, arrived at the fort below the city to undergo inspection and serve quarantine. The Deborah was a Philadelphia ship with a crew of 37 and 58 passengers. In his answers to the routine questions from the Health Inspectors, Captain Edward Yard attributed five deaths on the voyage to dysentery and claimed that at Jeremie people were "healthy on shore, but sickly in the harbor." <br /><br />While she stood quarantine six people from the ship were sent to the marine hospital. "A French black girl" died. Two seamen recovered. When two doctors sent by the Health Committee to certify the vessel healthy investigated on the 16th, they found two of the other sick seamen on the way to recovery. Their diseases did not appear contagious. Those who remained on board appeared healthy, and the ship very clean. Two ventilators had been used on it. <br /><br />The captain argued that the few deaths among white adults on the voyage were due to intemperance or lack of seasoning. On the 18th the doctors allowed the ship with its passengers and cargo of coffee, cocoa and sugar to move up to the city to unload at a wharf near Race Street. The doctors were concerned by reports that people had visited the ship. The Health Committee published a warning that ships visited while under quarantine would be required to serve an additional quarantine of five days. <br /> <br />On July 20 Dr. Samuel Griffitts was called to treat Thomas Wharton who had a store near Race Street. A veteran of the epidemics of '93 and '97, Griffitts recognized yellow fever and promptly bled his patient and administered enough mercury to bring on a salivation. Griffitts suspected that the fever was imported by a ship. He noted that Wharton's store was near the wharf where the Deborah was tied up. <br /><br />On the 25th the Deborah left the Race Street wharf to be taken to Kensington for repairs. Griffitts treated and cured another store keeper near the Race Street wharf, and then, on the 30th, had a fever patient below Walnut Street. The Deborah entered into that case too. Alexander Philips reportedly confessed that he had gone by boat down to the Deborah as she rode quarantine and brought up a sick man from the ship. Also on the 30th a carpenter in Kensington who had been working on the Deborah died of yellow fever. <br /><br />A mob reportedly tried to force the ship back into the river but Captain Yard had armed men protect it.<br /><br />By August 6 there enough reported cases of yellow fever to prompt 17 members of the College of Physicians to recommend that Water Street between Walnut and Spruce be evacuated and ships tied up there be relocated. The doctors counted at least 30 sick with the fever along the water front. In its public communications, the College did not blame the Deborah for importing the fever, but its private conviction was well<br />known. <br /><br />The story spread that Dr. Griffitts, a usually mild manner Quaker, confronted the brother of Captain Yard and blamed the Deborah for bringing the fever. The man "doubled his fist" and said his brother would "knock down anybody that said so." Griffitts stood his ground and asked where the man was who had come ashore sick. The captain's brother admitted that he was dead. Dr. William Currie began interviewing the Deborah's crew, getting admissions that it had left a port in the midst of a yellow fever epidemic.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-53040101205056605762011-05-03T13:04:00.000-07:002011-05-16T08:05:15.791-07:00First fever victim 1798﻿A man who worked on Philadelphia's docks died of yellow fever on July 2. The attending physicians, Wistar and Hodge, informed the Health Committee which ordered the house where he died, on Callowhill Road between 1st and 2nd Streets, thoroughly cleaned and whitewashed, and his bedding buried at the City Hospital. All those living in the house had to leave it and all those who had contact with the victim to leave the city. Needless to say the victim, those he lived with and those he associated with were all poor. <br /><br />These dire measures were announced in the newspapers and there is no way to verify that they were carried out. However, the country and city were mobilizing for an anticipated war with France. Local militias were being formed and in June elements of that home guard helped keep refugees in a ship from St. Domingue at bay when they tried to break a 10 day quarantine. A recently commissioned US Naval vessel enforced the quarantine.<br /><br />Temperatures were in the 90s on the 2nd and 3rd which increased anxieties. Then a cold front came through on the 4th, and the middle of July was uncommonly cool and pleasant. Nothing occurred to sustain concern. Dr. Hodge died, but he had a chronic liver ailment so there was no suggestion that he died of yellow fever.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-911921018074240262011-04-20T07:14:00.000-07:002011-04-20T08:41:20.769-07:00Cousin Amy's reportBrother William and his daughter Sally were both very ill. Amy reported on their cases to her cousin Abigail Robinson in Newport, Rhode Island:<br /><br />"Brother William took a large dose of active physick when he was first taken which had produced an abatement of his symptoms, was then put to bed and drank snake root tea till a profuse perspiration took place, but as there was no further care taken to carry off the putrid bile, and to prevent its accumulation, a lax and uneasiness in the bowels continued till the third or fourth day after he had taken the first mentioned medicine, to relieve this uneasiness the Physician who then attended him had given him one small dose of laudanum, which was in fact silencing the voice of nature that was calling for relief that way -- the effect of the first dose had gone off, and brother Wm. had sent into Sally's chamber for the second, when Dr. Jay who had just then arriv'd desir'd that he might not take it till he him, after which Dr.Hosack their first physician ceased visiting them.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-3mkM6lPj50Y/Ta7-X7BouhI/AAAAAAAAZQg/FjhyGwfMN8I/s1600/hosack.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 217px; height: 271px;" src="http://4.bp.blogspot.com/-3mkM6lPj50Y/Ta7-X7BouhI/AAAAAAAAZQg/FjhyGwfMN8I/s400/hosack.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5597691073803106834" /></a><br /><br />"Jay gave him frequently gentle doses of physick, such as salts and manna -- Rhubarb -- or an ounce of Rochelle salts dissolved in a pint of chicken broth and drank half at a time, and very frequent injections. Dr. H was giving Sally Marsh-rosemary with the same design as the Laudanum to her father, and wine by the way of cordial -- to her Jay gave an emetic, which reliev'd her of a nausea and reaching, and a very troublesome cough which H supposed to have proceeded from disorder'd lungs, when her fever was very high he bathed her feet in warm water into which he put some medicine -- and bound something on her forehead that had a very reviving effect and roused her from a death like sleep, in which she would lay for many hours and from which it was almost impossible to awake her. She was very putrid and seem'd as near a mortification as a person could be and escape, and this treatment join'd to such as has been describ'd in her father's case were the means of recovery."<br /><br />The family gave Amy great credit for her family's recovery. Amy also shared her general ideas on proper treatment.<br /><br />"I believe that nothing will give effectual relief in that disorder but a continued discharge of bile, but care should be taken to support with light nourishing diet, and the doses of physick moderate. This was the method of the greatest Medical Man. But tho one may relate the outlines of his method, it is impossible to give and for any but a very few to attain his sagacity in tracing disorders to their cause, and in discovering the difference of situations apparently similar. But it is astonishing that blunderers don't stumble upon this manner, for everyone within our knowledge has been reported to be better after the first purge, and have generally been thought likely to recover, but yet they have not taken the hint to go on in the same way, but have suffered the bile to accumulate have even given astringents to retain it, till it destroyed the bowels and produced a mortification.<br /><br />"There was a black man taken with the fever while Dr. Jay was at my brother Wm's -- to him he gave an ounce of salts at first, and salts in smaller quantities afterwards was all the medicine he took -- and tho I think he was more severely seized than either brother or Sally, he was well enough to go to town in five or six days."Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-70885591024379221862011-04-18T20:22:00.001-07:002011-04-19T17:47:56.377-07:00Dr. Elihu H. Smith's patients<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-1y1GrDsL6mk/Ta4hekUiVuI/AAAAAAAAZQA/GuULXk3-mTM/s1600/ehsmith.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 326px; height: 400px;" src="http://1.bp.blogspot.com/-1y1GrDsL6mk/Ta4hekUiVuI/AAAAAAAAZQA/GuULXk3-mTM/s400/ehsmith.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5597448195897710306" /></a><br /><br />﻿After graduating from Yale in 1786, when he was 15 years old, Elihu Hubbard Smith wrote poetry and edited one of the first collections of American poems. Then he got his medical degree at the University of Pennsylvania, and, inspired by the lectures of Dr. Benjamin Rush, moved to New York City to start his medical practice. He found that difficult and wavered in his resolve, contemplating instead starting a literary magazine or joining his father who was a pharmacist in Litchfield, Connecticut. In the meantime he wrote a libretto for an opera produced in New York. He followed the yellow fever epidemic of 1793 from afar, siding with his old mentor as Rush defended his regimen of bleeding and purging to treat yellow fever.<br /><br />In 1795, Dr. Amasa Dingley, another young doctor, invited Smith to join him in treating patients with yellow fever as New York City suffered an epidemic. Smith left a copious diary of his life then which, while it didn't describe cases in great detail, does show the idealism with which he fought the epidemic and his methods of treatment. He dedicated himself to proving the superiority of Rush's methods. <br /><br />"Do I not see ignorance, pride, stupidity, carelessness, & a superstitious veneration for foreign writers, & a mean jealousy of an illustrious writer of our own country, go hand in hand, & as it were, conspire, against the lives of men?" he asked himself in his journal. "I think I do. I think I have had sufficient opportunity to determine that his principles & practice are equally & certainly sound. I think I should apply them, in nearly all their extent."<br /><br />Smith soon had first hand experience of the efficacy of Rush's methods. He saw Dingley draw two pounds of blood from a man in two days, "with great advantage." Then when one of his own patients had a serious relapse with feeble pulse and severe fever, Smith brought out his lancet. "I determined to bleed him," he wrote in his journal. "He tottered out to a chair in the yard. I took away 18 oz. He rose, & walked, with a steady step, to the end of the yard; & after a discharge, returned; went down stairs, & returned to his room." <br /><br />Then Smith joined Dingley in trying to cure the apothecary Nathan Webb with bleeding and purges. Their patient suffered one of the worst side effects of bleeding. "We were near an hour employed in attempting to stop a bleeding which took place from a vein which had been opened before," Smith wrote in his diary. "The blood was entirely destroyed in its texture; the man stupidly insane; the house deserted; a negro nurse only remaining; except a drunken relation of the landlord, who with oaths & imprecations, refused to allow our moving the sick man, from an apartment five feet wide by twelve long, into an unoccupied, airy room. We did it however - & exerted every thing in our power to restore sensibility & hope to a man, thus forlorn, & without relation or friend near him, to yield any assistance."<br /><br />They returned the next day and found Webb dead.<br /><br />His experience in the epidemic convinced Smith to remain a doctor. He applied his literary talents to the creation and editing of America's first scientific journal, The Medical Repository<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-1JMZJjvlKH4/Ta4her029kI/AAAAAAAAZQI/-xmBbYO0USE/s1600/medrepository.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 237px; height: 400px;" src="http://1.bp.blogspot.com/-1JMZJjvlKH4/Ta4her029kI/AAAAAAAAZQI/-xmBbYO0USE/s400/medrepository.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5597448197912327746" /></a> <br /><br />He focused his own research on finding the cause of yellow fever and wrote a long monograph on 1795 epidemic in New York City in which he endorsed Rush's view that the disease was caused by a filthy environment. Ironically, in his diary, he frequently noted how bad mosquitoes were in the late summer and early fall of 1795. While treating patients in the early days of New York's 1798 epidemic, he contracted the disease and died on September 19. That will be the subject of another blog post. <br /><br />Here are excerpts from his monograph on the causes of the fever, in which he does mention mosquitoes but only blames them for predisposing people to get the fever not with causing it:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-7PpS0wuNvTw/Ta4s23U9ftI/AAAAAAAAZQQ/bwnGNcROCJs/s1600/tayloryellow.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 254px;" src="http://1.bp.blogspot.com/-7PpS0wuNvTw/Ta4s23U9ftI/AAAAAAAAZQQ/bwnGNcROCJs/s400/tayloryellow.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5597460707944529618" /></a><br /><br />Excerpts from "Letters From Dr. E. H. Smith to Dr. W. Buel" in Noah Webster's A Collection of Papers on the Subject of Bilious Fever, Prevalent in the United States for a Few Years Past. 1796<br /><br />[66]....Though the fever continued to extend itself, to the last, yet it never became general over the city; and, for a large time, was mostly confined to a particular district. As the season advanced, the peculiarities of this district may be supposed to have become common to a larger portion of the city; and this extension to the whole part only prevented by the letting in of winter. To the district alluded to, the East river, from Long-Island ferry to Mr. Rutger's [67] forms the eastern boundary; the northern reaches from thence to Division-street; thence westerly, down Division-street, Chatham-street, the extremity of Pearl-street, into William-street, to Franckfort-street, down this last to Gold-street, through that to Beekman-street, along which the line proceeds to Pearl street, as far as the Market, down which it should be continued to the river. - The space included in these bounds, is all over which the fever, according to the best of my remembrance, exerted any power, till after it had reached its height; when it extended down Water-street, a little below Wall-street, and proved very mortal. It is true that there were a few persons affected in various other parts of the town; but during the great part of the prevalence of the fever it was principally active in the north-eastern and middle parts of the district comprehended as above; and, as a thorough knowledge of the peculiarities of this portion of our city is, in my opinion, indispensable to the history of the disease which afflicted it, I cannot doubt your patience with the minute description I think it necessary to give. <br /><br />The first and most obvious remark, on the greater parft of the district, just pointed out, is, that it is the lowest, flattest, and most sunken part of the whole city. Some places are much more sunken than other; but the whole space is evidently so, compared with the adjacent ground; and appears to have an inclination, more of less observable, in different streets, to the East river. This inclination is very considerable in Dover-street; a street which is said always to have suffered from fevers of this kind, during the hot season. From the division of Pearl and Cherry-streets, down the latter, the descent is rapid, to somewhere near James's-street; about which is the lowest part of the street, and from whence it is nearly level [68] to the northern boundary. Beyond this bound, the ground rises again; and the made ground, by the river side, is also somewhat elevated: so likewise, is the whole ground over which the westerly line passes - through Division, Chatham, & c. streets. Thus you will perceive, that the part of the city where the fever was most active, for the longest period, forms, as it were, a basin, having its side, nearest the water, a little inclined. Within this basin, there are several smaller cavities; one of which, in particular, will require a further description. Those streets, also, which are no included in this hollow, but which lie along the river, will require some attention; which shall be given them. <br /><br />The extreme irregularity in the disposition of the streets, and the narrowness of the greater number of them, are great obstacles to a free ventilation of this city. This misfortune, common to every part of it, falls with peculiar heaviness on that district which has just been spoken of. The comparatively high and neighboring lands of Morrissania and Long-Island, receive almost solely the benefit of breezes from the north-east and east: The Sound, which divides them from the city, being too narrow to add much force and freshness to a breeze nearly spent on their heights. North, the island rises into little hills, from which the wind passes on to the high parts of the city; rarely visiting the low and intervening space; unless it may be the topmost rooms of the houses: and, as the houses are generally low, the effects of a wind from this quarter must be inconsiderable. - North-westerly, there is somewhat more of an opening; but even this is small. West, south west, and south, the other parts of the town, which are higher and thickly settled, break the force of the gales from these points. So that, thus situated, this quarter of [69] the city, though it were perfectly well laid out, would have but little chance for a free ventilation: irregularly disposed and narrow as the streets are, we must be convinced of the impossibility of its receiving the necessary supply of fresh air. You will understand me speaking of a thorough ventilation, and in the sultry season, when it is most necessary: a partial supply of air, equal to the support of a feverish existence, it undoubtedly obtains.<br /><br />Much of the ground, in the northern part of this district is swampy, and abounds with little pools and puddles of stagnant water. This was especially true last summer and autumn; there being great rains, and no adequate means for conducting off the water. Indeed, so flat are some of the paved streets, in this quarter, that the rains did not run down the gutters, but continued in little puddles, and were evaporated from the places where they fell. In the new streets, which are unpaved, and without any gutters, numerous imperfect ditches assisted the disposition of water to stagnate. These places were often muddy, when the southern part of the town was dry; and the streams from them very offensive, when the dry streets, towards the North river, were perfectly sweet.<br /><br />Several of the paved streets, and indeed the greater number, in the district of which I am speaking, are narrow and crooked; some with neither side walks nor gutters, and by far the largest portion of them miserably built. Most of those which are unpaved, are, in all respects, still worse; the buildings chiefly wooden, and placed on the ground; the old ones falling to decay; the new, but imperfectly finished. Of them all, it may be remarked, that they are much exposed, some of them more than others, to the full [70] influence of the docks, whatever that may be, and it cannot be salutary; or to that of a boiling sun, from early in the morning, till the middle of the afternoon; and some of them to both.<br /><br />So much for the streets, generally: a few particulars, concerning some of them, are necessary to the formation of a perfect idea of this district. <br /><br />A line, drawn from the corner of Ferry and Pearl streets, up the latter, to where William street enters it; then down William to Franckfort, and through that, a part of Gold and Ferry-streets, to Pearl-street again, will form the ridge of a new cavity (included in the principal boundaries above mentioned) which seems contrived, by art, for the dwelling place of fever. This court-yard of the palace of death, is divided by several dismal lanes, courteously denominated streets; such as Vanderwater, Rose and Jacob-streets, & c. which form the borders to innumerable tan-vats. The whole is one vast tan-yard, the firm parts of which seem to have been constructed by art in the midst of an extensive quagmire. To this place as far as I can discover, there is no outlet. Think what must be the condition of it, in the months of August and September! - Yet human beings live here; and habit renders its noxious exhalations, in some sort, harmless ot them. It is remarkable that few persons, regularly inhabiting this hollow, died of the fever last year. To those, whose evil destiny led them to seek a new dwelling place there, it proved highly pestilential.<br /><br />Dover-street is a short, narrow street, running from the beginning of Cherry-street, down to the East-river; and contains near twenty buildings -[71] ... rapid. As the exposure is nearly to the east, it receives the whole effect of the sun, from 6 a.m. to 3 p.m. in the summer. The descent makes it easy to keep the surface of the street clean; though it prevents a free ventilation. But it has been raised, several feet, since the buildings, which are mostly low, were erected; so that the road is, in many instances, up to the middle of the lower story windows; leaving the cellars to the houses, and cellar kitchens, without a communication with the street. The yards remaining as before, are, of consequence, much lower than the street; without vent; and, of necessity, all the water, and filth of every kind, which gathers in them, must there stagnate, ferment and putrify. Add to this, some of these yards are capacious, and contain little, decayed, wooden huts; sometimes built directly on the ground; and containing, oftentimes, several families.<br /><br />Water-street, above Dover-street, is chiefly composed of low, decayed and dirty wooden buildings. This street being either made-ground entirely, or raised like Dover-street, the same is true of the situation of the houses and yards. And, lest any of the filth, or water, should drain off, from any of the yards, the western side of Water-street has been kindly converted, by the enlightened zeal of the directors of these affairs, into a perfect dyke; which answers its design, most completely, by preventing even the slightest leakage. Beside, as this street lies directly on the water, it has the benefit of the whole force of the sun, the greater part of the day; and of the exhalations from the docks; which are here in great number, and in the highest state of their perfection. There is, however, a better opportunity for fresh air, in this, than in some other streets. Yet even this is an advantage which the rage for [72] improvement threatens to transfer to a new street, still further out in the river; which, if completed, may form another dyke, to the increased pleasantness and health of this quarter of the town.<br /><br />Of Roosevelt, Catharine, James, Oliver, &c. Streets, nearly the same remarks are true as of Dover and the upper part of Water-street: for though they are somewhat wider, straighter, and have more good and new buildings in them, yet they are raised in the same manner, have sunken yards, and under-ground apartments; and Roosevelt street has an open sink, where the drippings of the tea-water pump, after having gently collected all the filth in their way, are received; and being just enough to wash the gutter, or the sewer, the stench is most intolerable, during the sultry months,.<br /><br />Tio many other of these streets the same remarks will apply; and to some with aggravated force: but what has been said, will, perhaps, be sufficient to air your imagination in the conception of a just idea of their condition: I mean of their necessity and unavoidable condition. <br /><br />Of the Docks, it may be enough to mention, generally, that they are badly contrived in every part of the town; and worst of all, in their part; being broken up into numerous little wharves, thus forming narrow slip, where the ground is left bare at ebb tide; and where vegetable, animal, and excrementitious matters, being thrown in, at all times, instead o being cast into the stream, ferment, putrify, and render the stench truly pestiferous. Indeed, this is so much the case, with all of them, in the summer, that, except to persons habituated to their exhalations, [73] they are absolutely intolerable; exciting, in persons of a delicate make, immediate vomiting; and in othrs nausea, indigestion, head-ache, or some temporary illness, when exposed to hem but a short time.<br /><br />In addition to the above-related facts, concerning the condition of the streets, in that part of the city where care was most needed, it may be remarked that, at no time was there ever so great an apparent inattention to preserving them clean. Besides the impediments which the level nature of the streets, in many parts of the town, presented to the draining off of the filth which is constantly accumulating in large towns like this, artificial impediments were permitted; as if death were not sufficiently active, and needed the aid of the magistrate. In all the streets where buildings were going forward, the workmen were allowed to restrain the course of the water, in the gutters, by forming little dams, for their convenience in making their morter. The effect of this stoppage of water was so great, that even in Broadway, one of the streets the best calculated of any in the city for free ventilation, in that part of it where the new Tontine Tavern was building, the stench was exceedingly offensive. And in this condition it was allowed to remain for near two months; though it was almost under the windows of the principal magistrate of the city. If this were true of the widest, and one of the best aired and cleanest streets, of New-York, whay think you was the state of those narrow, crooked, flat, unpaved, muddy alleys, mentioned above? No one can form even a faint idea who has not walked through them, in the middle of some one of those deadly, suffocative days, which experienced in September last. <br /><br />[74] But this is not all: beside those masses of semi-putrid vegetable and animal matters - cabbage, turnips, the heads and entrails of fish, & c. which, at all times of the year, out of compassion to men who might be usefully employed as scavengers to the city, are allowed to complete the putrefactive process, undisturbed, in the middle of the streets - the sight and smell were shocked, at every turn, by dead rats, fowls, cats, dogs and pigs. So remarkably was this the case, that I question whether there could have been found a single street, alley, or even bye-lane, of any tolerable length, which did not lend its aid to render this exhibition full and frequent.<br /><br />.... p 76 Flies were very numerous and troublesome, in every part of the city, in the beginning of summer; but they suddenly disappeared, about the middle of July, from the more airy parts of the town, and succeeded, every where, by clouds of musketoes, incredibly large and distressing; and these continued to afflict us, long after the time when they commonly depart. Almost every person suffered exceedingly from the bites of these insects; and foreigners especially. In some they occasioned universal swellings, and eruption, somewhat like Pemphigus and in other numerous little ulcers. These last, a physician of my acquaintance, saw even in a native American. The irritation, restlessness, and consequent watchfulness and fatigue, occasioned by these animals, no doubt predisposed the well to be affected by the fever; while they extremely harassed the sick, and retarded their recovery.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-68977080783609224722011-04-18T20:19:00.001-07:002012-01-20T07:34:58.657-08:00Bellevue Patients 1795<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-uB_5jc7H5CU/TxmE-EGgDEI/AAAAAAAAf24/EEjozw4KAM8/s1600/belleview.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 220px; height: 136px;" src="http://4.bp.blogspot.com/-uB_5jc7H5CU/TxmE-EGgDEI/AAAAAAAAf24/EEjozw4KAM8/s400/belleview.gif" border="0" alt=""id="BLOGGER_PHOTO_ID_5699733005201837122" /></a><br />﻿At Bellevue four patients were admitted that day, including William Dewitt, a baker on Whitehall Street across from the Battery away from the supposed limits of the contagion. He was delirious and nothing Dr. Anderson did could stop it. Early the next morning Anderson found Dewitt had escaped and lay naked inside a nearby summer house. He was dying yet that afternoon had the strength to chase other patients with a club. It took three men to subdue him and push him into a little room where he died two hours later.<br /><br />Earlier in 1795 the New York City health committee purchased a house called Bellevue about a mile up the East River from the settled part of the city. <br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-n9tJPMkl7XQ/TxmH6D_RlPI/AAAAAAAAf3E/mlboopmGGEM/s1600/andersondock.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 251px;" src="http://1.bp.blogspot.com/-n9tJPMkl7XQ/TxmH6D_RlPI/AAAAAAAAf3E/mlboopmGGEM/s400/andersondock.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5699736234986935538" /></a><br /><br />They designated it as the city's "fever hospital." Anyone with yellow fever or in a condition that could be mistaken for yellow fever was to be sent there. The imperative was to keep the port of New York open by isolating fever victims far from it. What happened to Philadelphia in 1793 and New Haven in 1794 would not happen to New York.<br /><br />Dr. Anderson began working at Bellevue on August 24 and found 6 patients and a staff of 6: a steward and his wife, an old black gardener, a black nurse and two white nurses. On August 27th, Anderson met the full force of yellow fever. A<br />patient came who was "in a shocking condition - 10th day of the disease - vomiting blood by the mouthfuls." He died in two hours. A young girl who had nursed some one with the disease in town was brought out only to die despite Anderson's using Dr. Rush's remedies, purging and bleeding. On the last day of August one of the hospital nurses became sick. Suspecting fever, Anderson bled her, but a visiting Health Committee member insisted she had a drinking problem, not the fever. Then another<br />nurse quit after a fight with the steward's wife. Patients had to take care of each other.<br /><br />In all its public statements the Health Committee minimized any evidence that New York was having a yellow fever epidemic. What Dr. Anderson reported to the committee is not known. We know what he experienced from the diary he kept, now at the New-York Historical Society. <br /><br />Then 20 years old, Alexander Anderson was the son of a Scot auctioneer. His passions were wood engraving, poetry and playing the violin. His father decided Alexander would become a doctor and apprenticed him to Dr. Joseph Young when he was 14 years old. In his diary Anderson wrote more about art, poetry, religion and nature, than medicine. After two weeks on duty, Anderson thought seriously about quitting the hospital. He regained his equilibrium by taking a day off to sail down and visit his father one day, and take tea with his mother on another.<br /><br />On September 4 he counted 16 patients, then "5 or 6" more were admitted. One patient died the evening of the 6th, two died on the 7th. Then in the evening a patient came from his old master Dr. Young, as well as news that the doctor's Indian servant George had died and the doctor's brother was dangerously ill. Then William Dewitt experienced his rampaging death at Belleview. <br /><br />﻿Following the practice of Philadelphia in 1793, the Health Committee began publishing a daily toll of the dead, 11 on the September 17th, 14 on the 18th, but added this explanation to alleviate apprehensions: "a large proportion of the deaths hitherto reported have fallen among emigrants lately from Europe, strangers, and other transient persons." No mention of the baker Dewitt in particular.<br /><br />The committee tried to hide evidence that the epidemic had revived. It chastised gravediggers for opening more graves than the committee ordered. It tried to keep down the numbers sent to Bellevue by sending the sick to city physicians. It admonished the boatmen who took patients to Bellevue to stop acting so hastily, charging them with removing patients without warning. It sent a committee out to investigate Anderson's methods at Bellevue, suspecting he might be causing the increase in the number of deaths.<br /><br />No fault could be found, as Anderson used Rush's methods. The Committee sent another doctor to help Anderson but Dr. William Johnson soon got sick and recovered back in the city. As the fever spread through the east side of the city, Bellevue was more or less forgotten, except by some senior physicians who dissected the bodies of the dead trying to better understand the mysterious power of yellow fever. <br /><br />Anderson remained a doctor and served again at Bellevue during the 1798 epidemic. Its ferocity persuaded him to give up medicine and he became America's foremost wood engraver and popular illustrator.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-lBDGS_F_vS0/TxmH6fl4IpI/AAAAAAAAf3Q/UJq_V_9Yexw/s1600/andersonhorse.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 301px;" src="http://1.bp.blogspot.com/-lBDGS_F_vS0/TxmH6fl4IpI/AAAAAAAAf3Q/UJq_V_9Yexw/s400/andersonhorse.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5699736242396603026" /></a>Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-9050768401499132292011-04-18T20:15:00.000-07:002011-04-19T20:15:15.163-07:00Dr. Malachi Treat<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-GC34daI9p4A/Ta5NRqalh3I/AAAAAAAAZQY/kD7iEOpM5f4/s1600/Birch_View_of_New_York_Harbor.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 265px;" src="http://4.bp.blogspot.com/-GC34daI9p4A/Ta5NRqalh3I/AAAAAAAAZQY/kD7iEOpM5f4/s400/Birch_View_of_New_York_Harbor.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5597496352707020658" /></a><br /><br />﻿In late July New York's port physician, Dr. Malachi Treat, inspected the Zephyr, a ship from the West Indies that had three crew members sick with fevers. The ship's boy died the day Treat boarded the vessel. The doctor looked into a sack that held the corpse and thought he died of "bilious remitting fever," then the medical description of yellow fever. No one would believe his diagnosis.<br /><br />The captain of the Zephyr was anxious to land his cargo, and unceremoniously dumped water damaged coffee into the East River to hurry along inspection of his ship. He too was sick but described his own fever as dysentery, and claimed the boy died of worms. <br /><br />Alarmed at the putrefying corpse, Treat had it and himself rowed out to Nutten Island to assure its proper burial. When Treat himself got a fever, those jealous of the port's reputation for health pinpointed that exertion in the hot sun by a man known to have a chronic stomach disorder as the source of his fever, not his exposure to contagion on the Zephyr. Of course, while Treat's own fever could be explained away, his report of yellow fever was handed to the city's health committee. It toned down Treat's report, noting only that the boy had "suspicious symptoms." The ship's passengers were allowed to land.<br /><br />Then the ship William hauled up next to the Zephyr and several crew members soon had a bad fever. Common report described it as yellow fever. The port warden talked to the owner of the William who said there had been much sickness on board during its passage. The health committee kept the warden's report to itself.<br /> <br />Shortly before he died on July 29, a colleague visited Treat. He "knew me when I entered the room," Dr. William Smith wrote to a doctor in Philadelphia a month later, "he looked yellow, red, and bloated - his extremities cold - his pulse irregular - he raised himself in bed, and seemed willing to make unavailing efforts to get on the floor, which I dissuaded him from - he said if he could stop his gulping he should do well - it was a mixt spasmodic affection, I could hardly tell whether most a hiccup or an effort to vomit - it produced no evacuation - I inquired of him whether he thought himself under the influence of infection - he answered, and nothing more was said on the subject - 'Ah Dr. I don't know' - 'sometimes I think - But don't you think' - his debilitated intellect labored under a gloomy incertitude!" He died eight hours later. <br /><br />In the week after he died there were eulogies in the newspapers, but no mention of nor speculation on the cause of his death.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-30420083522396902552011-04-18T07:44:00.000-07:002011-04-26T12:25:02.076-07:00Margaret Morris's Servants﻿Although he cited his missing a visit as reason enough for a patient to die, after he succumbed to disease, Dr. Rush encouraged people to carry-on without him by liberally using mercurial purges. After she recovered from her own sickness Margaret Morris treated her maid Sally, who seemed to have a mild case, "as Dr. Rush directs." Then she began vomiting "blackish stuff and the discharge downwards was the same, and then she vomited blood." Morris "began to make experiments." She had Sally lick salt and alum and then quenched the resulting thirst with elixir of vitriol, vinegar and water. Her discharges stopped for 24 hours. Then she started vomiting blood again, "It came out like a teapot." Morris went to her neighbor Rush and got medicine to stop the vomiting, but the bleeding continued and Sally's mouth, tongue and lips were as black as ink. Morris gave her bark, and she recovered. The convalescing Rush told Morris that the spontaneous bleeding cured Sally.<br /> <br />While Sally was sick, William, an apprentice who was staying with Margaret, was seized. She started him with purges and Fisher, one of Dr. Rush's apprentices, stopped in to bleed a pound of blood out of him in the morning and another pound that night. He seemed weak but better. No sooner were the patients in her own house stabilized than Benjamin Smith, her son-in-law, reported that his three servants were ill. With medicines in hand Margaret went to Front Street and purged everyone. Then the two Smith children felt ill.<br /> <br />Back on Walnut Street Margaret's cousin succumbed to the fever. "Practice had made me bold," Margaret later wrote. She gave her cousin a purging powder, and had her bled. Then the two grandchildren living with her got sick. She had not thought the Smith children truly touched with yellow fever, but she had no doubts about the Morris orphans. She asked Rush how to proportion the medicine to the children and dosed them both. One recovered quickly the other didn't. Then the two blacks she had hired to take care of Sally and William got sick and left. With all the sickness, she wrote, "it seemed as if my heart had died within me." To care for all she decided to spend the days at the Smith house and nights in her own house. <br /><br />Here is one of her letters, written October 10 that describes her ordeal:<br /><br /><span style="font-style:italic;">but then it was a little after my maid S, was taken sick - we did not think her bad, as she had a fever only one night however she was treated as Dr. Rush directs & all went on well till the next 7th day, when she began to vomit blackish stuff & the discharge downward was the same & about noon that day, a vomiting of blood succeeded; I sent for Dr. Park who had attended her at the first, he said it was a hopeless case & came no more, till sent, however while there was life, there might be hope and I began to make experiments. I made her ---- lick fine salt and a little allum - this made her thirsty & I gave her Elixir Vitriol, Vinegar & Water - & it stopt for 24 hours- & then the bleeding returned, it came out like a tea pot, & we had 2 large tubs full of sheets & c, that were quite stiff - Dr. Rush was sick & Dr G the same, however I went myself to Rush, told him all about it, he gave me a Medc for her- & sent one of his pupils to see her - to make short of my story, the bleeding continued several days and nights, her mouth & tongue & lips as black as ink - then I gave the bark - when Dr. Rush saw her he said the bleeding had saved her life & thro mercy is now quite well - while she was at the worst, William was taken ill & very violently seized. I gave him the Medicine & next morning sent for the Doctor - he was bled 16 ounces & the same again at night. I got a black man to attend him - Sally and myself being in the front - & I sent 2 of the children to B Smith's & 2 to the G F as Sally's disorder now became infectious - I got a woman to attend her & returned to my own room upstairs - this was yesterday week & that morning our dear sister had another stroke of the palsy as I apprehend, for she had not a fitt, she was suddenly seized as I thought with death - her chin fallen, eyes fixt, - speechless & insensible for many hours - fitts of hiccuping & no motion in her limbs. I sent for good Dr. Rush & tho he was hardly able to walk he came - & found in the opinion of her having had another stroke advised a blister on the head - which as usual restored her to sensibility - she had a high fever & when it went off, a black vomiting - & the same kind of purging for 2 days - this reduced her very low & I ventured to give musk julep - which provd very salutary & she was restored to nearly her former state - but when we came to take her up, found her more helpless than ever - so that 2 could not do it - Today she has had a violent fitt & lays sleeping as usual. I have not yet finished my tale of woe - for last first day morning BS came to tell me his 3 servants & both his children were ill - he a got a Dr. & I went there to bring my S & Molly home - but they desired me to let S stay as she could help Debby while he went out to look for Women to attend the sick - so I brot Molly with me - & when I came home found E Hix a bed & very ill with a fever - practice had made me bold & I gave a powder - but the fever rising I got a Dr to feel her pulse -& she was bled - she has had the disorder light & is able to set up a little - tho still weak & low - The same night my little Molly was taken with the fever & a violent purging & sick stomach & on 2d day morning my Sally was brought home very ill. I really thought she wd not live till night. Dr. Rush again applyed to - he sent me word it was impossible to attend he was so poorly & his pupils so fully employed they could not come, but directed the medicine for the child & thro mercy Sally is got about again & as well as ever, but my little Molly still drooping - Debby being fatigued with her servants and children has been obligd to submit to keep her room - has been bled & physickd & I hope will have it light - she has 2 hired women there & her servants are out of danger but her little Peggy is very poorly - Yesterday the woman I had hired took sick & left me & today the black man was also seized with the same & is gone - so there is now only DH & myself to wait on the invalid - I've been out & engaged a Woman to come tomorrow, & hope DH will hold up - I've scoured her well, had her bled, & spared her as much as possible - Dr G[riffitts] has been at Deaths door; he had been bled 7 times since this day week & livd on toast & water, - dear Bn W gains a little ground. S Marsh had the fever very light - but has now relapsed & is going thro the same regimen again - H &RW pretty weak. H has been bled 4 times - Sis W had a little complaint in her Stomach yesterday - but is better today, Cos HG has been very ill, but I hope will get up again - Danl Offley is very ill - probably this night will terminate his life on Earth. - I'm much obliged for thy offer of Vinegar, if we want, shall do as thee desires - Most of the apothecarys are shut up, but I'll try to get the drops for thee as soon as I can. There are 52 orphan children taken care of by the committee - whose parents have died in the present calamity & 16 infants put out to wet nurses - I think the Loganion Library is converted into an orphan house - the inclosed memo of persons deceased I made as I'd recollect the names & had some knowledge of most of them - but it is a small part compared to what could be collected - the Committee recd L100 today from the Jerseys for the use of the Sick at Bush Hill & the suffering in the City - My very dear love to all - Oh my Sally if we meet again on Earth, what joy it will be to fold thee thee to the offered (?) bosom of the own MM</span>Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-84906048780253630272011-04-18T07:40:00.000-07:002011-05-03T12:35:53.170-07:00Ebenezer Hazard<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-M7UyPIrmGzo/TcBYum4n5AI/AAAAAAAAZmo/GUTCfx0DeIc/s1600/hazard.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 300px; height: 373px;" src="http://4.bp.blogspot.com/-M7UyPIrmGzo/TcBYum4n5AI/AAAAAAAAZmo/GUTCfx0DeIc/s400/hazard.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5602575494184166402" /></a><br />﻿Although their relationship had been cool for several years, Ebenezer Hazard had once been Dr. Benjamin Rush's best friend. When Hazard, a merchant and sometimes public official, feared he had caught the fever, he called Rush but found him as exasperating as ever. On Monday, Rush thought him "very ill" but not in immediate danger, and had Hazard lose 12 to 15 ounces of blood and take a mercury pill. On Tuesday he thought Hazard still "in jeopardy," and he had him lose another 10 ounces of blood and continue taking pills. On Wednesday Rush once again prescribed bleeding. Hazard felt his own pulse and objected. Rush warned him, Hazard wrote, that "this opinion [is] one of the most dangerous symptoms of the case; the disorder was extremely insidious; the case extremely critical; not a moment to be lost; send for the bleeder directly. In the mean time, take this pill; and, if that does not operate in one hour, take this. You must be glystered today; but, if your not bled today, I shall not be surprised to hear that you are dead tomorrow." <br /><br />Hazard called in Dr. Hodge, who offered to consult with Rush, as they had often done before. Rush refused, and, in a letter to his wife fumed that Hodge "has seen a great deal of the disorder, but he is no more wiser for it than the black nurses who attend the sick."<br /> <br />Hodge prescribed Peruvian bark and wine. As he recovered Hazard recoiled at the newspaper ads for "Dr. Rush's Mercurial Sweating Purge," which reminded him of ads for a "mountebank." Recalling the doctor in the novel Gil Blas, Hazard dismissed Rush as "a perfect Sangrado, [who] would order blood enough to be drawn to fill Mambrino's helmet, with as little ceremony as a mosquito would fill himself upon your leg." <br /><br />Rush wrote to his wife that purging and bleeding "laid the foundation" of Hazard's cure.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-75200507891852381992011-04-18T07:36:00.001-07:002011-04-18T08:25:38.980-07:00Margaret Wistar HainesMargaret Haines was a Quaker famed for her tireless work with the poor. However since the beginning of the epidemic the 64 year old woman confined herself to her house, entertained in the main by Rebecca Jones, a preeminent Quaker "preacher," who preached that one could not escape the rod. When Margaret had "a severe chill," followed by a "smart fever," she sent her daughter away, "for it's a serious thing to visit the sick at his awful time," and asked for an African American nurse.<br /> <br />The nurse her daughter hired seemed "little used to good nursing," but she proved to be "very attentive," and "pleased" the patient. Margaret's son came into the city, much to the distress of his wife. Margaret kept him from her room arguing that coming from the country air he was too vulnerable. She looked at him from a window. He stayed in the house, anxiously taking preventatives like Fothergill's pills which "opened" his body "cleverly." When he went to the door to talk to his mother he had "garlick or segar constantly" in his mouth. He worried that the letters he sent to his wife in the country might carry infection so he smoked them and wrote warnings on<br />the envelop, e.g. "don't let the bearer come into the house," or "turn this horse into the pasture and then nobody go near him." He was discomforted by the warm temperature, in the low 80s that weekend, and found "they have more misketoos in the house than I remember and wonder how they can sleep at all."<br /><br />Margaret was bled and blistered by Dr. Parke. She let Daniel Offley pass into the<br />sickroom because he had visited many of the sick. Offley did more than comfort Margaret. When a prominent Quaker like Haines died, a notice describing her life and her demeanor at death was included in the Society's records. Offley waited through her deliriums and heard her repeat twice, "O Lord, thy will and not mine be done, be with me to the end if it be thy holy will, blessed be thy name, forever and ever." Her daughter, who did sneak into her room, got chills and then fever, and took to her own bed feeling as if she had been blessed. The nurse could provide what little<br />else her dying mother needed, so she, the daughter, could die happily, for her "life had been spared while I was capable to render any assistance or relief to my dearest and valued parent."<br /><br />She went to her room with "a black lad who was to stay that night with me." After "dreadful conflict and bodily suffering," Margaret died quietly at 5 a.m. Her daughter's fever abated. The distraught son did not get infected and was encouraged by friends to believe that he had done all a dutiful son could.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-2499779975058610942011-04-18T07:31:00.000-07:002011-04-21T13:45:34.396-07:00Samuel Powel<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-HnKSYFnODuc/TbCN5m1McEI/AAAAAAAAZQw/zzchQjOLfTI/s1600/powel.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 200px; height: 253px;" src="http://1.bp.blogspot.com/-HnKSYFnODuc/TbCN5m1McEI/AAAAAAAAZQw/zzchQjOLfTI/s400/powel.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5598130357637247042" /></a><br /><br />﻿Samuel Powel was a former mayor of Philadelphia and current Speaker of the Pennsylvania Senate who lived with his wife Elizabeth Willing Powel in their Society Hill townhouse on South Third Street. Although not much a hill that section of the city was high enough so that it was widely assumed that those living there would be exempt from the fevers that tormented those who lived in lower parts of the city.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/-JYKe8QEzz-s/TbCN57qRITI/AAAAAAAAZQ4/PPZxYSsbZ3E/s1600/powelhouse.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 380px; height: 400px;" src="http://3.bp.blogspot.com/-JYKe8QEzz-s/TbCN57qRITI/AAAAAAAAZQ4/PPZxYSsbZ3E/s400/powelhouse.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5598130363228561714" /></a><br /><br />The Powels were good friends with President Washington and his wife Martha. Since Congress was not in session in the Fall, the President usually returned to Mount Vernon to rest up for the upcoming congressional session. In 1793 the ceremonial laying of the cornerstone of the Capitol building in Washington was scheduled for September 18, convenient to Washington's trip to Mount Vernon. Washington was well aware of the yellow fever epidemic as the time came near for his scheduled departure. He authorized the removal of federal government clerks from the infected city and arranged for some federal officers to continue to maintain needed government services which meant that some Treasury clerks and Post Office employees remained in the city.<br /><br />Mindful of the threat of the epidemic to their friends, the Washingtons invited the Powels to join them in Mount Vernon. Mrs. Powel declined the invitation saying that her husband "thought there was no propriety in the citizens fleeing from the one spot where doctors were conversant with the treatment of the fever...."<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/-d6wLw73SLCM/TauTt3zBnOI/AAAAAAAAZPo/Kfa5lLs2Yf4/s1600/powel.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 215px;" src="http://2.bp.blogspot.com/-d6wLw73SLCM/TauTt3zBnOI/AAAAAAAAZPo/Kfa5lLs2Yf4/s400/powel.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596729378219334882" /></a><br /><br />Powel's resolve prompted the President reconsidered his plans and he decided to remain in the city as long as possible, but his wife refused to leave without him, so the Washingtons left as scheduled on September 10. Some of his biographers suggest that if Washington had any romantic interest in any woman other than Martha, it was with Elizabeth Willing Powel.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/--0mEltFwEo0/TbCN5XkJ2II/AAAAAAAAZQo/Qu-E-Mwjl7U/s1600/mrspowel.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 281px; height: 344px;" src="http://1.bp.blogspot.com/--0mEltFwEo0/TbCN5XkJ2II/AAAAAAAAZQo/Qu-E-Mwjl7U/s400/mrspowel.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5598130353539242114" /></a> <br /><br />As the fever progressed, not sparing those who remained on Society Hill, Mrs. Powel moved to her brother's estate in Chester. Her husband divided his time between Chester and Society Hill. When he became ill with the fever on September 25th, he found a bed in a small, bare farm house he owned just across the Schuylkill River. Samuel Powel was also a close friend of Dr. Benjamin Rush who by September 9, when Powel declined the Washingtons' invitation, thought he had a powerful treatment for yellow fever, calomel purges and frequent copious bleeding as dictated by the rate of the patient's pulse. <br /><br />Rush was the doctor who held Powel's confidence. So he sent his old African American coachman to Rush, and Rush sent back a prescription. Powel hired a young doctor in the neighborhood to attend him and follow Rush's orders. Later in the day, after the bleeding and purging, Powel sent a note back to Rush: "I certainly don't feel worse for the operation. The discharge from my bowels are exactly as you described them."<br /> <br />Rush visited Powel on the 26th. Early Saturday morning, September 28 Rush was woken by Dr. Samuel Powel Griffitt, Powel's nephew. He told Rush that his uncle was in a desperate situation. Rush went to the small farmhouse, failed to revive him and left Griffitt to lessen the agony of his old friend's death. Powel died on the 29th.<br /><br />As a rule, to keep up his courage and maintain his effectiveness for helping the living, Rush avoided the dying. That a former mayor, reputed one of the wealthiest men in the city, who was well attended during his illness, should be near death after using his remedies, did not give Rush pause. He blamed "the neglect of a 4th bleeding by the young doctor who attended him."Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-80985298295287811702011-04-17T17:46:00.000-07:002011-04-26T12:08:25.623-07:00Dr. John Morris﻿On Friday evening a servant informed Margaret Morris that her son Dr. John Morris was sick. The relationship between them was strained. Like Ephraim of the Bible, he had "joined himself to Idols," i.e. he was a drunkard. She forgot his transgressions and rushed to his Pear Street house. She found two doctors there, Thomas Parke and Samuel Powel Griffitts, both Quakers like Morris. They had prescribed a blister and Rush's calomel and jalap. They thought he had favorable symptoms and would recover. Margaret thought her son "struck with death."<br /><br />All the doctors' prescriptions worked exactly as they should. Still on Saturday morning "his skin was as yellow as gold." He had convulsions and was delirious. The family maid had two days before to attend her sick mother, leaving only a 10 year old indentured servant girl to help John's wife Abby care for four children including a baby. Margaret took charge of the situation, sending the two older children to their grandfather Benedict Dorsey, a respected Quaker grocer who lived four blocks away. Heeding Rush's initial alarms, he refused to take them in,<br />afraid they were carrying the disease. The children's mother, Abby, went to change his mind. While she was gone, her husband had one of his strongest fits. Margaret could not call on the frightened children for help. When Abby returned she provided no relief. She never told her mother-in-law what her father said to her. She simply "went upstairs, undrest and went to bed, saying she had got the disorder and she'd die." She lay in the room next to her husband. Margaret sent the baby to a wet nurse, the toddler to her house, and again sent two children to their grandfather. When they didn't return, she felt more encouraged as she faced the difficult task<br />before her. As she scouted the Morris house, in which she had been a stranger since her estrangement from her son, she found the Morris boy cowering in the cellar. His grandfather had only taken his sister. Margaret sent him to Benjamin Smith with a message that she needed help.<br /><br />The mayor's letter relaying the offer of the Free African Society to provide nurses,<br />appeared in all the newspapers at the end of the week. As the ad instructed, Smith applied to Absalom Jones and William Gray who both lived near Pear Street, and by the evening a man and woman came to help Margaret Morris. As was the case in most of the letters describing their help, the nurses remained nameless.<br /> <br />Soon after the nurses arrived Rush came to see his colleague. Dr. Griffitts had the fever and asked Rush to attend his patients. Rush was gratified to see the black nurses. The Free African Society had provided nurses for most of his patients. He gave Dr. Morris more calomel and jalap, and while not much encouraged, told Margaret that his fever was lower. He did not see Abby in the next room. Evidently Margaret viewed her as afraid, not sick with the fever. Still she had to be attended during the night. Margaret wanted to stay with her son and decided that she would feel more comfortable with the woman nurse. The male nurse sat by Abby. Shortly after one o'clock Margaret gained the first sleep she had had in two days.<br /><br />Margaret Morris woke at about 5 a.m.. felt her son's pulse, and "thought the fever gone off." She tried to give him medicine but he could not take it. She feared the worse, sent the male nurse to get Benjamin Smith and had the woman stay with Abby. Three weeks later she recalled her son's last moments. He was sensible for the first time in three days and mother and son were able to reconcile: "he spoke to me in a manner that poured balm into my wounded heart, lamenting errors of his past life and had hopes of mercy. This was all I had presumed to ask for, and my chastened spirit said 'thy will be done.' A convulsion fit followed, and after that a sweet composure took possession of his features and he departed without sigh, groan or struggle."<br /> <br />She knew that her son had to be buried within hours to save all the smell of his corpse. That the morning was cloudy and cooler was a blessing, but she decided not to wait for family to help her prepare the body for the grave. Rush began his morning rounds by visiting the Morris house, arriving soon after the doctor died. "His excellent mother rushed from his bed into my arms," Rush wrote to his wife that night, "fell upon my neck, and in this position gave vent to the most pathetic and eloquent exclamations of grief that I have ever heard. I was dumb and finding<br />myself sinking into sympathy, tore myself from her arms and ran to other scenes of distress."<br /><br />Margaret managed to prepare her son for the grave and even see him buried promptly,<br />with the help of the Free African Society that organized a group of black men to handle infected corpses. But Benjamin Smith saw that she was "scarcely any longer herself." She collapsed in complete prostration. Benjamin had her carried back to her own house and sent for Rush. Smith also arranged to move Abby Morris. When her father refused to take her in, the business-like Smith didn't recriminate against the most un-Quakerly act and solicited the help of the relative who had the most commodious house, Richard Wells, cashier of the Bank of North America. Wells polled each member of his household on North Third Street and they all agreed to take<br />Abby in.<br /> <br />Rush was unable to see Margaret until the morning. He found her resting comfortably and determined that she was only exhausted.<br /><br />The letters Rush wrote to his wife, sometimes he wrote two a day, are a major source for the above. The main source is what Margaret Morris wrote in letters to members of her family outside the city. Here is an excerpt from a September 25th letter to her sister describing Dr. Morris's sickness and death:<br /><br />Will it fatigue thee my Patty to read a Narrative of what I've past thro since we parted? I think thee answer no - Well then I'll begin my tale of woe from the 5th of this Mo[nth] - when I returned that eve from my Debby, who was not well enough to be about the house, was told my Dear JM [her son Dr. John Morris] was ill & wishd to see me - I went there immediately & found him very ill with a raging fever. Dr. Park & Griffitts both attending - I faithfully followed their orders - the blister drew finely - the powder had all the effect could be wished - alas - in the morning his skin was yellow as gold - a convulsion fitt & delirium deprived me of hope - yet the repetition of the powders, which operated well, revived me again, & I was willing to flatter myself - he might recover- As AM's [Abby, Mrs. John Morris] Maid was called away on 4th day to attend her mother who was ill, they had only a little girl to tend the child & I told AM to write a note & beg her F[ather] to let P[atty]. & Molly stay there, that the house might be quiet, they soon returned saying that their G[rand] F[ather] was sick & they could not be there This alrmed my poor A - & she begged to go see her F & stayed an hour or more - when she returned & went up stairs, undrest & went to bed, saying she had got the disorder & she'd die. She did not come into JM's room afterwards - I then had 2 to nurse & 2 little ones down stairs to provide for - at last I sent thy namesake and Wm again to the GF. Patty, they kept, & on going in the kitchen, found Wm hid in the cellar, he said they would not let him stay, they were afraid he wd bring the disorder to them. I sent M to my house. On 7th day B[enjamin] S[mith, her son-in-law] came there & kindly went about town to procure assistance for me, & after night sent a black man and woman to me - who were but just done nursing at another place. Dr. Rush came that day & tho he could not flatter me, assured me the fever was lower at night - I watched by him till about one oclock & having been up the 2 preceding night was quite spent & as he slept quite easy, I lay down by him - the Negro woman sitting near to the bed - about 5 I awoke - & feeling his pulse, thought the fever was near gone off, & went to give the medicine but he could not take it - he spoke to me in a manner that poured balm into my wounded heart, lament the errors of his past life & had hopes of mercy - this was all I had presumed to ask for & my chastend spirit said thy will be done - a convulsion fitt followed & after that a sweet composure took possession of his features & he departed without sigh, groan or struggle - All this time I was alone, the woman I had was with Abby - the Man I sent to B Smith who took care to provide the coffin & after sitting by him awhile - Oh then the hands of the pitiful Mother prepared her Child's body for the grave & well it had been if I had contented myself with doing all that was required of me - but alas I got off my guard & thought that I who had been thus supported was equal to every thing & insisted on seeing laid beside the dear Companion of my youth - & there my fortitude forsook me - for that was not required of me - what followed I know not - till I found myself 2 days after in my own front parlor in the bed I had provided for others....Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-35816310230611747612011-04-17T17:25:00.000-07:002011-04-17T17:42:22.711-07:00Dr. Deveze's Bush Hill cases<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/-M-WxEdDNm4c/TauIorZrAsI/AAAAAAAAZPg/VNcn_ran7gg/s1600/bushhill.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 398px; height: 290px;" src="http://3.bp.blogspot.com/-M-WxEdDNm4c/TauIorZrAsI/AAAAAAAAZPg/VNcn_ran7gg/s400/bushhill.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596717194364519106" /></a><br />First Observation<br /><br />A man between thirty-six and thirty-eight years of age, middle sized, bilious temperament, hair and beard black, was admitted into Bush-hil hospital on the 29th of September 1793. He could not say how many days he had been ill, but was informed the first or second day of the fever he had taken a drastic medicine, composed of jalap and calomel. The tongue and lips were very black and dry, respiration painful, and extremities cold; he threw up with violence all he took, his belly was hard and painful, the abdominal muscles were is such a state of contraction as to flatten the belly in a manner that it almost touched the backbone; the faeces were black, of an ill smell, and mixed with blood; the urine in small quantity, also black and foetid; in short, the pulse was concentrated, and the tendons convulsed. I had blisters applied, and hot bricks to the extremities. I endeavoured to get some remedy down his throat, but in vain; nature was so weakened art could not re-animate him. He died in the night of the 1st of October. The second I opened his body and found:<br /><br />The membranes of the brain in their natural state; the sinews of the duramater contained a very little black blood; the brain firm, the curtical substance less red than it should have been, the medulla substance too white, the ? artery and plexus choroides discoloured and almost white, the ventricle scarcely containy any serosity.<br /><br />The lungs in their natural state, the pericardium containing very little serosity, the heart withered and wrinkles, absolutely not containing any thing, pale, appearing as if it had been washed and of a flabby consistency.<br /><br />The stomach a little contracted in thickness double what it ought to be, the internal membrane partly destroyed, what remained was red and inflamed. the duodenum and almost all the whole intestinal canal in the same situation, what remained of the internal membranes appeared blocked in proportion as I apporached the larger intestines, the passages were lined with a black, glairous, bloody matter of a faetid smell; the liver, gall bladder, pancreas, and kidneys in a natural state. In opening the liver I found a small quantity of black blood, the spleen black, withered, and of a consistence less firm than its natural state; the mesentery black towards the spine, its membranes having opened formed a bag, that was filled with blood extremely black; that, contained in the largest abdominal veins was of the same color; in short, the bladder was contracted , and contained but a small quantity of black faetid urine, and the internal membrane was spotted with a brown color.<br /><br />Second Observation<br /><br />The first of October, a man about thirty-three years of age was admitted into the hospital. He was insensible, cold, and almost without pulse; his mouth half open, and full of black blood; his respiration low, quick, and interrupted; his body deep yellow. Those who accompanied him told me, in answer to my questions, that he had been ill some days, but did not say how many, and that he had taken many medical powders similar to the preceding patient.<br /><br />Every method I made use of to re-animate the vital powers, were useless; the patient died during the night. The second I opened him; the head shewed nothing different from the preceding body.<br /><br />The lungs even appeared in their natural state, except some adhesions, but they were old and were found between the pleura and the right lobes.<br /><br />The pericardium contained a little serous matter of a deep yellow; the heart withered, empty, and the right auricle full of very black blood.<br /><br />The stomach, which I found more than double its natural thickness, contained also, as well as the intestinal canal, black blood, and bile also black, sometimes mixed together, and sometimes separate, the internal membrane of these parts almost entirely destroyed, the little that remained was mortified, detached, and floating in matter; the mesentary, towards the intestines, was inflamed; the glands very much swelled and black; it contained yellow pus between its two membranes near the spine; the gall bladder was empty, the liver, spleen, and veins in their natural state; the pancreas, hard and inflamed, was about twice as large as it ought to be; the urine was black and faetid; the internal membrane of the bladder mortified.<br /><br />Third Observation<br /><br />A man, thirty-four years of age, of a sanguine and robust habit, accustomed to drinking, fell sick the 11th of October, after a debauch in which he had drank brandy to excess. I saw him at the hospital the first day of the disease; he had a burning heat, his skin was hot and dry, his face the colour of crimson, his eyes sparkling, he was extremely thirsty, his tongue very dry and covered with a fir that was pale yellow, his respiration high and difficult, he vomited with violent straining green and yellow bile, his pulse was hard and tight, he complained of pains in the epigastric region, and in the head.<br /><br />I had him bled in the arm, and ordered clysters made with a decoction of flax seed, a bath, and lemonade with nitre. In the afternoon, find the symptoms not diminished, I had him bled again.<br /><br />The day after, being the Second, I had him twice bled, and prescribed the same remedy, but he threw up every liquid.<br /><br />The third day he experienced lassitude, his pulse became intermittent, his eyes and skin yellow, his stools were glastrous, mixed with blood, the abdomen was neither extended nor painful, the little urine that came up from him was bloody. In short, he vomited green and yellow matter, mixed with blood.<br /><br />In this melancholy situation I gave him water acidulated with dulcified spirits of nitre, and gave order at the same time to change the drink according to his fancy; they gave that he wished, but he vomited every thing immediately, and nothing could remain on his stomach.<br /><br />The fourth he experienced weakness, and the whole body was of a deep yellow, the extremities became cold, the pulse little and intermittent, his respiration more difficult, the faeces continued to be marked with a glaucous bloody matter, and strength wore away by degress; in short he died on the 15th of October, the beginning of the fifth day. He preserved his senses to the last.<br /><br />By the opening of his body I found that the serocity contained in the ventricle of the brain was very yellow; the rest of the head offered nothing remarkable.<br /><br />The lungs on the outward part were covered with black spots; in dividing them I found they were gorged with a black frothy blood; the humour of the pericardium was yellow, the heart absolutely empty, its right auricle contained black blood.<br /><br />The stomach was extended by the air it contained, it was almost double the thickness it ought to be, and contained clots of black blood; the internal membrane was inflammed but unequally, the red was in some places brighter than others, that of the duodenum and other intestines were in the same situation; clots of black blood and glairous matter of the same colour lined the intestinal canal; the vessels of the mesentery were choaked and also contained black blood.<br /><br />The bladder contained a little bloody urine, and the internal membrane was very much inflamed.<br /><br />Fourth Observation<br /><br />The 15th of October I saw a young man at the hospital, about twenty-six years of age. He was brought the evening before, and had been sick five days, druing which he had taken three doses of drastic powders, composed of jalap and calomel. He was of a bilious temperament, small made and had chestnut coloured hair.<br /><br />He had a great deal of fever, his skin was burning hot, breathing difficult, tongue dry and very red, he was very thirsty, and made many efforts to vomit; he had violent pains in the abdomen, instead of faeces pure blood came from him, his pulse was strong and frequent, he made some few drops of urine, with great pain, and of a deep colour.<br /><br />I ordered him lemonade with nirtre, a simple ? emolient clysters, cataplasms on the lower belly, and had him bled three times in the course of the day.<br /><br />The 16th I saw no other change than the weakness he felt on going to stool; every thing he swallowed instantly came up again with most violent and painful efforts; his beverage returned from his stomach mixed with blood. I tried many methods to stop the vomiting, but in vain, he was in continual agitation till death, wished to lie on the ground, and said he had a fire burning within him; these agitations terminated in weakness, which carried him off the 18th, at the end of the seventh day. <br /><br />On opening his body I made the following observations: the corridal plexus was not as high coloured as in its natural state, the brain was firm, and the ventricles without serosity, the sinuses of the duramater contained very little blood, but of a brown-red colour; the right lobes of the lungs were much inflamed, the left in a natural state, no serosity in the pericardium, the heart was empty, its right auricle contained a clot of blood that did not stick to it; when I took it out I saw another that followed and came from the vena cava inferior; it was three inches long, and of two colours; the part that answered to the exterior of the auricle white and resembled the blood of those who have the pleurisy; the rest, as well as what came out of the vena cava, was a red brown;... the stomach contained blood, as well as the intestines, the internal membrane was much inflamed, the pylorus mortified, and the intestines had inflammatory and gangrenous spots; the liver white on the outside was gorged with very black blood, the spleen appeared in its natural state, the pancreas hard and inflamed, the bladder which I found in its natural state contained a very little red blood.<br /><br />Fifth Observation<br /><br />A woman, about thirty-four years of age, robust, of a sanguine habit, and that had been sick about six days, entered the hospital the 4th of October. She told me the first day she was ill she had taken two doses of drastic powders, which took no effect; she was very red and violently oppressed; her pulse intermittent, hard, and tight; her tongue red and dry, she was peculiarly thirsty, her skin hot, she felt a pain and tightness in the left hypochondria, she was uneasy and could not remain long in the same place. I had her bled in the arm and gave her lemonade acidulated with dulcified spirits of nitre; also prescribed emollient glysters and a bath.<br /><br />In the afternoon, the same symptoms remained; the blood that had been taken from her was absolutely without serosity. I ordered a second bleeding, which could not take place on account of an extreme faintness, that seized her at the moment the surgeon was about to open the vain; he had even much difficulty in bringing her to again; it seized her every time she ? to dring. The 16th I found her insensible, and she died shortly after. The 17th I opened her body and found: [I'll copy this later.]<br /><br />Sixth Observation<br /><br />A man about fifty years of age, of a bilious temperament, hair and beard grey, came into the hospital the 21st of October. He told me he had felt great weakness for some time, and had been very ill about six weeks previous. He was very weak, his pulse slow, and almost in its natural state; said he had occasion for food, and asked for something to eat. I gave him soup, and for drink Bordeaux wine with water. He reamined in the same state three days, and except the weakness seemed well, and said he felt no pain.<br /><br />The 31st he was oppressed, his eyes became yellow, and pulse weak. I prescribed him as a remedy, a lincus of water, honey, and styllitic oxymel; and for his common drink, water and honey. The 1st of November the whole body became yellow, his nose bled, his tongue was covered with blood, he spit a great deal in the afternoon, respiration became painful, and the extremities cold; his urine was black, as also the bile he vomited, his pulse became intermittent, he had a palpitation which very much incommoded him. I prescribed a decoction of bark, acidulated with spirits of vitriol, a camphorated cordial draught, and wine with sugar was given in table spoonfuls. The second he was worse; to the symptoms of the preceding day were joined black and bloody faeces; he vomited often, his strength insensibly decreased, and he died on the morning of the third. In the afternoon I opened his body....<br /><br />Seventh Observation<br /><br />The 27th of October a man about thirty-eight was brought to the hospital. He was insensible almost without pulse, cold, mouth half open, eyes yellow, open, and fixed.<br /><br />I had large blisters applied to the legs, and hot bricks to the extremities; I ordred a cordial draught in case he should be able to swallow it; all these means ? operated insensibly; the 30th he recovered his senses and speech, told me he had been ill eight days when brought to the hospital. I found him so well as to give hope of curing him, consequently had him carried from the chamber of the dying into another room. The second, he refused the decoction of the bark which I had ordered, he took creamed rice and diet drinks, he continued tolerably well till the 5th day on which day his pulse became litte and concentrated, the blisters dried up, the extremeties became cold and livid.<br /><br />I again ordered the decoction of the bark, and a draught, antiputrescent and cordial. I had the blisters dressed with the ungent of storax, his extremities were fomented, but all was useless - the progress of the mortification increased every day, the slough fell from the blisters; the 8th supperation was re-established, the patient took all they gave him, every function was perfect, and he said he felt no pain; he preserved his senses till the 11th, on which day he again became insensible, his pulse intermittent and scarcely perceptible, he had an infectious smell, the breath from his lungs was cold and stinking, he was at length in such a state as to be unable to swallow, he had convulsed motions in the tendons. He died the 12th in the morning; in the afternoon I opened him, and found:....<br /><br />Eighth Observation<br /><br />The 17th of November I saw a young man about twenty-five years of age. He had been brought to the hospital the evening before, and told me he had been ill five days; he had a high fever, his skin was burning about the body, though his extremeties had only their usual heat; he complained of a seeming fire in the inside; was thirsty, his tongue and lips black and dry, his respiration laborious and frequent, the breath from the lungs considerably hot, his eyes were very yellow, his person livid and very thin, instead of faeces glairous yellow frothy matter came from him, his urine was red, he threw up all he drank, became worse and died the 19th, the seventh day of his disease. The 20th, I opened his body: the lungs were spotted with red and black, the pericardium contained a little yellow serosity, in the heart was found blood of a pale red colour.<br /><br />The liver was of an olive green colour, in the interior as well as exterior parts; the gall bladder of an extraordinary size, it floated in the abdomen, extended to the inferior part of the illiac region, and was marbled with black; I took it out with care, and weighed it with the bile it contained; I found it twelve ounces three drachms; the bile when put in a vase was of a green black colour, and of the consistence of white of egg.<br /><br />The spleen was hard on the outside, the inside resembled conserve of red roses by its consistency and red colour; the stomack was contracted, and did not contain any thing, the internal membrane was slightly inflamed, that of the duodenum in the same state; the intestines contained glairous yellow frothy matter, the internal membrane had spots slightly inflamed; the pancreas hard, red, and rather larger than in it natural state; the internal membrane of the bladder inflamed, the urine extremely red, the mesentery and pyplon contained no fat.<br /><br />Ninth Observation<br /><br />A woman, about twenty-eight years of age, robust, and of a sanguine habit, entered the hospital the 30th of September. She was attacked with the fever two days before; her respiration was short, quick, and hot; pulse hard and tight, face red, eyes watery and bright, skin hot and dry; she had pains in the head and epigastrick region, her urine was in small quantity and very red, she vomited white glairous matter of so strong an acid as to set her teeth on edge, her tongue was dry and red, accompanied by excessive thirst.<br /><br />I prescribed bathing, and bleeding in the arm, which I had repeated in the afternoon, and gave her as a beverage, water mixed with volatile concreted alkali, in each bottle I put ten grains and two ounces of simple syrup.<br /><br />The next day, being the third, she was affected with the same symptoms, and felt such extreme uneasiness, as to be continually wishing to change her place; the remedies were continued as before, with the addition of ten grains of fat of tartar, and lemon juice, to be taken at the moment of effervescence, and repeated twice a day, also every half hour a grain of camphire, with three grains of nitre in form of a bolus.<br /><br />In the afternoon she was less agitated; her pulse a little dilated, the vomiting and pain in the epigastrick region ceased about noon; her tongue was moist, and a little white; she complained of pain in the reins [in French "d'une fore douleur aux lombes."] The bolus and alkalised water were continued as before.<br /><br />The fourth day in the morning, her tongue was ash coloured, and mouth clammy; she had two evacuation of green, bilious, frothy, yellow matter. I prescribed half an ounce of cream of tartar, and two grains of emetic tartar, to be dissolved in a pint of water, and taken in three doses, at the distance of an hour each, observing not to repeat them, if either produced vomiting two or three times. In the afternoon she was without fever, with a moisture on the skin, had taken the whole of the remedy, and vomited five times white glair, mixed with green bile; she had also eight motions.<br /><br />I ordered strong broth, creamed rice, and for the evening (as she had been deprived of sleep from the time she fell sick) a jalap, composed of fifteen drops of liquid laudanum, four ounces of common water, and an ounce of simple syrup.<br /><br />The fifth day passed without fever; she took creamed rice, and the usual drink. The following day I gave her a cathartic. The seventh passed without fever. The eighth she again took an opening medicine, and was then sent among the convalescent, where she recovered, and left the hospital in perfect health.<br /><br />Tenth Observation<br /><br />The 30th of September I saw a young man, about twenty years of age, of a sanguine habit, who had been ill two days, and was bled at home. His respiration was high, pulse quick and short, face inflamed, eyes sparkling, skin dry and hot; he had pains about the heart and in the head, his tongue was red and dry, he was thirsty, and vomited yellow matter with violence; for some days he had been costive, his urine was red and in small quantity.<br /><br />I prescribed bathing, emollient clysters, water acidulated with fixed air for common drink, and bolusses of camphire and nitre. The following day, the third of the disease, the symptoms were the same, as was the remedy. The fourth, the symptoms had diminished; his tongue was incrusted but moist, he had a disagreeable taste, and had not vomited since the night; his abdomen was swelled, but not painful. I prescribed an ounce of cream of tartar in water and syrup, which remedy produced five or six evacuations of white gairous matter; in the afternoon he took broth several times. The fifth day he was much agitated, changing his place continually; the symptoms of the third returned with equal violence, and the same remedies were continued.<br /><br />The sixth day he was much fatigued, had neither slept nor vomited; he had a pain in the loins, that of the head and epigastrick region had left him; the abdomen was swelled but not painful.<br /><br />The seventh day he was very uneasy, vomited green and yellow bile, and almost all he drank; with the abdomen painful, the head-ache returned, his breath was short and quick, pulse weaker, shewing an approaching state of debility.<br /><br />In the afternoon he had an evacuation of white and glairous matter, the head ache and vomiting ceased, respiration became easier, which determined me not to apply blisters; but I ordered creamed rice, and wine with sugar to support his strength.<br /><br />On the eighth he was oppressed; I gave him wine and water, creamed rice, and wine with sugar. The ninth he was much agitated, with the abdomen swelled and painful, he threw up all he drank, his respiration was much confined; about two in the afternoon a bloody flux appeared; it was glairous and of a foetid smell, then the vomiting ceased, respiration became free, and thought he had several evacuations, was not so weak in the morning. The tenth the flux continued.<br /><br />The eleventh it was more considerable, swelling of the abdomen continued, the pulse and waving and the skin moist.<br /><br />The twelth and thirteenth passed tolerably well, the flux being less; his tongue was covered with a fir of a dirty white colour.<br /><br />The fourteenth day passed without fever, I administered three drachms of rhubarb, and two ounces of manna. This medicine had a good effect; the blood totally disappeared after the two first evacuation, the fever also gave way, and did not return.<br /><br />On the sixteenth he took a similar dose; and on the seventeenth was sent among the convalescent, from whence he went out in perfect health.<br /><br />Eleventh Observation<br /><br />The seventeenth of October a man was brought to the hospital, about forty-five years of age. He was insensible, with his mouth open, tongue and teeth black, the body cold, and almost without pulse, respiration was short and slow: he was placed on his arrival in the chamber with the dying. I prescribed an antiputrescent, and cordial draught, ordered hot bricks to his extremities, and wine with sugar to be given him. He remained in the same state till the 19th, when I found the pulse raised, his senses returned, and tongue was moist. He complained of a pain in the genitals, which were much enlarged; the testicles, spermatic cords, and scrotum were much swelled, the latter was covered with blisters and gangrenous spots; the penis was four times as large as it ought to be, and covered with spots like the scrotum; the prepuce formed a phimoses.<br /><br />I ordered a strong decoction of bark, acidulated with spirits of nitre, a quarter of a glass was taken every hour, and a table spoonful of a camphorated draught taken every half hour; his usual drink was water acidulated with fixed air; his food creamed rice. An emollient cataplasm was put on the genitals.<br /><br />The 20th I found him much better, but the moritifaction had fixed on the penis. I made an incision as deep as the part would admit, and had the poultices composed with spirits of turpentine, and camphorated spirits of wine; the internal remedies were the same.<br /><br />The 21st I took away the skin that was loose from the incision of the preceding evening; the part was dressed with the unguent of storax, and cataplasms appled as before upon the testicles. The 22nd the suppuration began; as it gradually augmented the other parts decreased, and assumed their natural size. This patient left the hospital perfectly re-established, after having taken the decoction of bark, and water acidulated with fixed air for a length of time; when he ceased their use the suppuration became bad, and fever returned. His cure was compleated by cathartics, administered in proportion as the suppuration dried up, and the cicatrice formed.<br /><br />Twelvth Observation<br /><br />The third of November a young girl between twelve and thirteen was brought to the hospital. She told me she had been ill several days; her eyes and skin were very yellow, the latter dry and of a burning heat; she was thirsty, with a quick pulse, and interrupted perspiration; she had an hemorrage from both mouth and nostrils, the blood from the latter was very red, the drops that fell on the sides of the bason appeared composed of little globules which were not adhesive.<br /><br />I prescribed a camphorated draught, and for ? drink, water acidulated with fixed air. The following day the heat of the skin diminished, but the other symptoms remained; to the remedies already given, I added a decoction of bark, acidulated with spirits of vitriol; and as the patient was very weak, she had during the day four cups of veal broth, in each of which was ? half a drachm of gum dragant in powder; she also took some spoonfuls of sweetened red wine.<br /><br />The 9th, she complained of a sore throat. I made her a gargle with a mixture of water, styllitic oxymel, and honey, acidulated with spirits of vitriol. The hemorrage continued with the same force till the 13th, on which day it was more considerable; the 14th it entirely disappeared, as did the other symptoms; the remedies were then laid aside, and she continued to recover. I gave her a cathartic some days after, and sent her to the convalescent from whom she went out perfectly recovered.<br /><br />Thirteenth Observation<br /><br />The 27th of September, a young woman, about twenty-six years of age, was brought to the hospital. She was of a phlegmatic constitution, and had a fit of sickness a short time before. She was attacked with the fever in the morning; her skin was dry, tongue and lips in the same state; she felt a lassitude and pain in the epigastick region, she had a difficulty in breathing, and was thirsty; her urine was excor? and small quantity.<br /><br />I prescribed a cooling antiputrescent draught, and water acidulated with dulcified spirit of nitre, sweetened with simple syrup.<br /><br />The second she became yellow, and vomited bile of different colours. The third the yellow was deeper, all the symptoms of the second day had increased with violence, the vomiting fatigued her very much; to avoid the pain she refused to drink; at night her tongue was covered with blood. The fourth a quantity came from both mouth and nostrils; she was excessively weak.<br /><br />The fifth her pusle was low and intermittent, she lost much blood, and was greatly oppressed; her tendons were much convulsed. I ordered blisters to her leg and prescribed decoction of bark acidulated with spirits of vitriol, wine with sugar, and broth with gum dragant, as in the preceding case. In the evening she was senseless, and almost without pulse; she mechanically applied her fingers to her nose, which she pinched, and covered her face with the black blood that came from both mouth and nostrils; her face was entirely yellow, mouth and eyes half open, which gave her a most hideous appearance. I had hot bricks applied to her extremities, which were cold, as also upon the blisters; and ordered a cordial draught to be given in spoonsfuls, when she should be able to swallow.<br /><br />The sixth I found her better, but her senses were imperfect and ideas confused; she swallowed mechanically all that was put in her mouth; the blisters rose well, and discharged thick pus. I supported her with cordialified tincture of bark, wine, and broth.<br /><br />The seventh she relapsed, and was as on the fifth; the blisters were covered with a dry gangrenous slough and the hemorrage continued. I found her in a desperate situation, and had her warmed with hot bricks as before.<br /><br />The eighth, ninth and tenth she was the same, and did not recover her senses till the eleventh; then the mortified slough fell from the blisters, and suppuration was great. She continued the acidulated bark till the twentieth, when the hemorrage ceased; she also used a detergent gargle, to brace and cleanse the inside of the mouth, which was excoriated and covered with little ulcers, her lips were in the same state and swelled. I made use of means to support her strength, gave her cathartics when the blisters dried up, and sent her among the convalscent, where she entirely recovered.<br /><br />Fourteenth Observation<br /><br />The third of December, a woman acbout thirty-eight years of age, robust, and of a sanguine habit, had been taken ill the evening before. She had pains in the head and back, her face was red, respiration short and quick, skin dry and of a burning heat, tongue also dry and red; she was thirsty, with a hard and tight pulse, her abdomen painful, but not swelled; she was bled twice that day, had emollient clysters, and chicken water with nitre.<br /><br />The third day she felt great uneasiness and gastrical pain, she changed her position continually; the fever was very strong, her urine red and in small quantity; she continued the chicken water, to which I added water acidulated with dulcified spirits of nitre.<br /><br />I found her better on the fourth; her tongue was covered with a white fir, her mouth clammy and bitter; the irritable symptoms appeared calmed. I prescribed half an ounce of cream of tartar, and two gains ot emetic tartar, to be dissolved in two glasses of water, and taken in three doses at the distance of n hour each. She took only two-thirds of this remedy, as she vomited a quantity of green and yellow bile with glairous matter, and had three motions; she took some light broth, and in the afternoon continued the chicken and acidulated water; and in the evening had a clyster.<br /><br />There was a sensible change on the fifth. On the sixth she was much oppressed; could not lie but sat on the side of the bed; and was much weakened by frequent evacuations of liquid matter. In the afternoon the pulse became low and convulsive. I had blisters applied to her legs, and prescribed draughts composed of four ounces of common water, an equal quantity of rose water, thirty grains of prepared cachoe, an ounce and a half of spiritious cinnamon water, and two ounces of simple syrup. A table spoonful to be taken every half hour.<br /><br />The seventh she was fatigued and agitated, changing her situation every moment, had pains in her bones, and an oppression so great as to be obliged to sit up in bed; she had a burning skin, and great thirst, took whatever was offered her; her urine was red and in small quantity; she had convulsive motions in the tendons, and the solids were in a state of irritation.<br /><br />I prescribed a draught of eight ounces of common water, twenty grains of Homberg's sedative salts, thirty-six drops of Hoffman's mineral liquor, and two ounces of simple syrup to be taken by the table spoonful every half hour; the blisters were taken off about four in the afternoon, there was a great deal of pus; the pain in the loins and evacuations ceased, her face was red, she had a violent head-ache and oppression, her nose began to bleed about six in the morning, and her pulse became concentrated. I gave her wine with sugar. At nine o'clock she became cold; hot napkins were applied to her extremities, and she swallowed some spoonfuls of a cordial draught, which was occasionally repeated till morning.<br /><br />The next day, being the eighth, the patient was so bad as to be almost without pulse, was forced to press very close to feel it, it was intermittent; she had convulsive motions in the tendons, and had not recovered any warmth; her respiration was difficult, and the hemorrage violent; her tongue was moist, and she was extremely weak.<br /><br />I prescribed a decoction of four ounces of red bark in a pint of water, and added to it twenty drops of spirits of nitre, She took two table spoonfuls of this remedy every hour, and in the intervals red wine with sugar, broth, and creamed rice, or barley.<br /><br />Towards elelven o'clock her pulse raised, respiration was easier; the hemorrage continued as before. At four in the afternoon she became weak as in the morning, lost a great deal of blood, and breathed with difficulty; her urine was thick and of the colour of strong beer, it was put in glasses but did not settle; her pulse was scarcely to be felt; her senses continued perfect, though her weakness was so great. When the blisters were drest, they were dry, and covered with gangrenous slough. I had unguent storax applied. She continued the decoction of bark, wine broth and creamed barley.<br /><br />The morning of the ninth I found her better, the oppression had ceased; but she fainted at four o'clock; the hemorrage was considerable all night, but entirely disappeared in the morning; she had two foetid evacuations in substance; her urine was abundant, and had a cloud in it that did not settle; her skin was humid and of an equal natural heat; she felt easy.<br /><br />The regimen and remedy of the preceding day were continued. The tenth she was rather stronger, and ? easy in bed, had slept during the night; her pulse was expanded, and fever ceased, a natural heat only ? , the urine was in quantity and thick, as was a white sedimentary deposited; the slough began to detach itself from the blisters; the remedies were continued the same. The eleventh her tongue was firred, and had a disagreeable taste. She had no evacuation from the ninth. I gave her three drachms of glauber's salts, and two ounces of manna, dissolved in two glasses of water, which she took in three doses; the evacuation was great, and consisted of bilious glairous matter of an infectious smell. At night she was without fever, and stronger notwithstanding the great evacuation.<br /><br />The twelvth passed without accident. She took her food the thirteenth. On the fourteenth the slough was entirely detached; suppuration was abundant, and completed the cure. The patient took an opening medicine after the blisters had dried up. She had no relapse, and was perfectly re-established.<br /><br />Fifteenth Observation<br /><br />A man of about fifty years of age, entered the hospital the 29th of September, with a tetanus; his jaw was so very fast locked, it was difficult to put a small spoon between his teeth to give him drink. The disease became worse, he was stiff in every part, and bent backward. He refused every remedy. I had him carried into the chamber of the dying. As he saw numbers expire on all sides, victims to the epidemic, and their beds immediately re-occupied by others, the terrifying spectacle no doubt suggested to him some very serious reflections; and he immediately asked for some drink. As my visits were as frequent in this room as in the others, I perceived the change, and having some hope from it, prescribed remedies suitable to the case. He found himself very soon relieved, the action of swallowing became free, and by degrees the disease gave way. At the end of twenty-five days he was well enough to sit upright, when he went into another apartment. His cure was not retarded though he was continually with those that had the epidemic; he was perfectly re-established, and went out of the hospital the 19th of November, in a better state of health than he had previous to the disease.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-lOMSM1xloQw/TauGYJYLIFI/AAAAAAAAZPY/Kp2AlxJekTw/s1600/deveze1820.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 240px; height: 400px;" src="http://1.bp.blogspot.com/-lOMSM1xloQw/TauGYJYLIFI/AAAAAAAAZPY/Kp2AlxJekTw/s400/deveze1820.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596714711330267218" /></a>Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-31309343395496972132011-04-12T18:22:00.000-07:002011-04-15T20:03:48.084-07:00Dr. James Hutchinson<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/-T4cI7FstGKY/TaUAt2d_HiI/AAAAAAAAY3Y/GT_SLsQXOeY/s1600/hutchinson.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 200px; height: 284px;" src="http://2.bp.blogspot.com/-T4cI7FstGKY/TaUAt2d_HiI/AAAAAAAAY3Y/GT_SLsQXOeY/s400/hutchinson.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5594878899793108514" /></a><br />On Saturday morning Dr. James Hutchinson awoke with a sharp pain in his head. The night before he had dined with Secretary of State Thomas Jefferson at an estate along the Schuylkill. Famous as the former ambassador to France's wine cellar was, Hutchinson knew he did not have a hangover. At dinner he had described the fever's symptoms to Jefferson. It "begins with a pain in the head," and could end in death "from the 2nd to the 8th day."<br /><br />Hutchinson summoned Dr. Adam Kuhn, considered by many the city's best practitioner.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-DcVzNnrWzLs/TaUEB-omb5I/AAAAAAAAY3g/Itrd7FcpRV8/s1600/kuhn.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 200px; height: 220px;" src="http://1.bp.blogspot.com/-DcVzNnrWzLs/TaUEB-omb5I/AAAAAAAAY3g/Itrd7FcpRV8/s400/kuhn.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5594882544117378962" /></a><br />Hutchinson explained how "he had gone to bed about 11 o'clock perfectly well and he indeed never felt better or in higher spirits." At three, he woke with "a most violent headache attended with fever." A few days before, Kuhn had opined that only 9 people had died of yellow fever in the city. So he quizzed Hutchinson sharply, asking several times if he had a chill, a pain in the back or uneasiness in the stomach. "He declared that he had no chill, sickness, or pain any where but in his head, which he described as excruciating." Kuhn noted that his skin was dry, his pulse "not much more frequent and not fuller than in health."<br /><br />Kuhn suggested that Hutchinson take a lenient purge. The two doctors decided that cream of tartar would be best. Hutchinson's wife, who was in her ninth month of pregnancy, was an uneasy bystander during this consultation. "With great anxiety," Kuhn recalled, she asked him if her husband had yellow fever. Hutchinson saw Kuhn's embarrassment and "immediately answered there was no doubt of it. A week ago he had examined the houses along Water Street" where several people had died of fevers. Kuhn did not disagree. <br /><br />That evening Kuhn returned to his patient. He had had one bowel movement "of a putrid nature." Once the stomach and bowels were evacuated, Kuhn treated putrid fever by using remedies that would "produce a fermentation in the stomach and correct putrefaction." He suggested wine whey and water, or lemonade, and ripe fruit. Once putrefaction was checked he would "restore tone to the system." Hutchinson indicated he wanted a tonic and chose elixir of vitriol, sulfuric acid in wine with cinnamon and ginger which thanks to it's "grateful acid taste," had been a popular pick-me-up at least since 75 B.C. <br /><br />Kuhn also suggested a cold bath of which doctors with experience in the West Indies spoke so highly. When Kuhn left, Hutchinson had himself splashed with cold water and found it refreshing. He also decided he didn't feel adequately purged. He took more cream of tartar and passed a restless Saturday night. <br /><br />The cream of tartar inspired three bowel movements that Sunday and the whale of a man who weighed over 300 pounds had gone down two flights of stairs and his back steps so that he could do it in the out house. Kuhn thought Hutchinson was too weak for such exertion, and expressed "extreme regret." During the night Hutchinson could not stop his bowels, and had eight more movements. Kuhn thought that very dangerous in a putrid fever and tried to stop it with laudanum, an opiate. He also prescribed one ounce of Peruvian bark as a tonic.<br /><br />Hutchinson passed 10 stools on Monday and had bleeding hemorrhoids. Kuhn was not sanguine, as he explained to Samuel Coates, president of the Pennsylvania Hospital, whom he met in the streets: "What would you think of him venturing down three pairs of stairs, after such a severe illness. He would have whipped one of his own patients for such an act of impudence." Kuhn said he had great hopes of recovery, but no more, "Hutchinson must submit to his fate." <br /><br />Hutchinson summoned two younger doctors, William Currie and Benjamin Barton. Currie came Tuesday evening, Hutchinson was sitting up talking, lucid enough to describe his own case and give Currie permission to write about in a book he was preparing that described the current fever epidemic.<br /><br />Hutchinson told Currie that he liked the baths and vitriolic salt tonics. When he felt well, as he did then, he took no medicine but lime juice punch. In the essay Currie would send to the printer at the end of the week, Hutchinson's treatment was held up as a model. <br /><br />After Currie left him on Tuesday night, Hutchinson walked downstairs. When he came back up, his nose bled until "he was much debilitated and faint." He took 45 drops of laudanum, got to sleep, and rested well until he awoke "with sickness and great distress." <br /><br />Currie came back at 10 o'clock Wednesday morning and found Hutchinson with a low pulse, and cold and dry skin. His face was bloated and livid. "His mind was considerably deranged -his thirst became insatiable - he cast up all he drank, as soon as his stomach became full, with straining and noise." When he wasn't puking he was hiccupping. No matter what medicine Currie suggested, Hutchinson "obstinately" refused it, claiming that "nothing was the matter." Currie sent his manuscript to the printer anyway.<br /><br />On Thursday the 5th Dr. Benjamin Rush went to Hutchinson. He found the massive doctor "sitting in a chair near the head of his bed, with all his clothes on, as if he had been in his usual health." But he wasn't. Rush saw that he was delirious with a face "suffused with blood." Rush urged "a strong mercurial purge," explaining that it had saved 29 out of 30 who had taken it. Hutchinson refused for the moment, but did send one of his apprentices to Kuhn. "Rush should know," Kuhn replied sharply, "that Hutchinson had 30 stools in three days." He did not need further purging. <br /><br />On Thursday morning he lapsed into a coma. ﻿Hutchinson lived through Friday in a coma. He died Saturday. His wife went into labor that same day, and bore him his fifth child, a girl. His began to "mortify before he died," and had to be buried in a hurry that night. <br /><br />Hutchinson's friends were inconsolable. His obituary was in newspapers all over the country. "For five days no two or more persons met when the first interrogatory was not 'How does Hutchinson.'" the young editor Samuel Smith wrote to his sister. "Now he is no more - but I cannot dwell on the gloomy subject." Hutchinson had given Smith courage to stay in the city, but as he sealed his letter, a carriage waited to take him to Lancaster 60 miles away.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-45704153060227983472011-04-06T09:41:00.000-07:002011-04-16T10:45:27.992-07:00First Two Cases 1793<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/-z4bLSl-Z8So/TakH5eXfqxI/AAAAAAAAZPA/j4g1iyFPAPw/s1600/archwharf1.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 342px;" src="http://4.bp.blogspot.com/-z4bLSl-Z8So/TakH5eXfqxI/AAAAAAAAZPA/j4g1iyFPAPw/s400/archwharf1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596012695970097938" /></a><br />The port cities of America in the late colonial and Federal period were not quaint. Urban land speculation and its attendant evils of shoddy housing, over crowding and unconscionable profiteering thrived. An English traveler, Isaac Weld, described Philadelphia's Water Street in his Travels Through the States of North America...During the Years 1795, 1796 and 1797:<br /><br />"Behind these wharfs, and parallel to the river, runs Water-Street. This is the first street which you usually enter after landing, and it does not serve to give a stranger a very favourable opinion either of the neatness or commodiousness of the public ways of Philadelphia. It is no more than thirty feet wide, and immediately behind the houses, which stand on the side farthest from the water, a high bank, supposed to be the old bank of the river, rises, which renders the air very confined. Added to this, such stenches at times prevail in it, owing in part to the quantity of filth and dirt that is suffered to remain on the pavement, and in part to what is deposited in waste houses, of which there are several in the street, that it is really dreadful to pass through it.... " (pp.3-4)<br /><br />Most modern histories of the yellow fever epidemic say that refugees from the country we now call Haiti, mostly white French colonialist and their personal slaves, brought yellow fever to Philadelphia. All American ports then were alive to the threat to public health that immigrants posed, but at the time there was mostly sympathy for the once rich French, not fear of their diseases even though some had the flu. In general it was the immigrants to the New World who suffered as they failed to survive what was called "seasoning," that first year in the New World which after two hundred years of experience Europeans had come to realize could be very dangerous. <br /><br />For example an Englishman who had just arrived and an Irish woman who had landed in June 1793 both died at Dennie's North Water Street boarding house on August 4 and 6 respectively. <br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/-G9iY48NNEww/TakH5SYppGI/AAAAAAAAZPI/e9aqjAWU_ag/s1600/phila1762water1.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 274px; height: 388px;" src="http://2.bp.blogspot.com/-G9iY48NNEww/TakH5SYppGI/AAAAAAAAZPI/e9aqjAWU_ag/s400/phila1762water1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596012692753720418" /></a><br /><br />Both were well attended thanks to the tax supported Overseers of the Poor and the privately supported Dispensary which assigned two young physicians, Philip Syng Physick and Isaac Cathrall, to treat the unfortunate emigrants. Physick thought the Englishman, a Mr. Moore, died so quickly that he might have been poisoned. Physick performed an autopsy, but found nothing suggesting poison.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/-KRZnlAR1ZA4/TakJzJTnuPI/AAAAAAAAZPQ/pndU8DhelXs/s1600/physick.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 245px; height: 230px;" src="http://3.bp.blogspot.com/-KRZnlAR1ZA4/TakJzJTnuPI/AAAAAAAAZPQ/pndU8DhelXs/s400/physick.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596014786260744434" /></a> <br /><br />In time Physick would become America's leading surgeon but even as a young man he had impressive bona fides. After getting his medical degree at Edinburgh, then the leading medical school in the English speaking world, he worked with Dr. John Hunter in London, arguably the leading doctor in the English speaking world. Isaac Cathrall ha also just returned to Philadelphia from medical studies in Edinburgh, London and Paris.<br /><br />Cathrall marveled at the long morbid dance the fever put the Irish woman, Mrs. Parkinson, through: severe head and back pains, great thirst, offensive stools, much vomiting, delirium, red spots on face and breast, blindness, sore throat, hiccuping and death. She had languished a room away from the Englishman whose symptoms, coma and death in 24 hours, were completely different. <br /><br />Her family remained healthy. Malignant as the fever was, it evidently was not contagious, and so what passed was deemed business as usual on Philadelphia's Water Street, the storied landfall for most emigrants where not much account was taken of those who died before they moved beyond it.<br /><br />When the city organized the Bush Hill fever hospital, Physick and Cathrall were made the attending physicians, which meant that they visited the hospital every day. They used their association with the hospital which mainly served the poor to conduct more autopsies on fever victims. This was common procedure in London and Paris where the use of poor patients could go to the extreme of not treating them in order to study the natural course of a disease. There is no evidence that Physick and Cathrall did that. However, they were replaced at Bush Hill by Dr. Deveze who was an recent immigrant with no private patients and was able to devote all his time to the hospital.<br /><br />They did not keep their autopsies secret. In the midst of the 1793 epidemic they published a summary of their findings after several autopsies. It makes interesting reading in two respects. It shows that doctors then appreciated the importance of morbid anatomy. In his account of the epidemic, Dr. Benjamin Rush quoted this autopsy report in full seeing its findings as supporting his analysis of the disease. More interesting is that such a report was printed in a popular newspaper during the epidemic:<br /><br /><span style="font-style:italic;">Being well assured of the great importance of dissection of morbid bodies in the investigation of the nature of diseases, we have thought it of consequence that some of those dead of the present prevailing malignant fever should be examined; and, without enlarging on our observations, it appears at present sufficient to state the following facts.<br /><br />1st That the brain in all parts has been found in a natural condition.<br /></span><br /><span style="font-style:italic;">2d That the viscera of the thorax are perfectly sound. The blood, however, in the heart and veins is fluid, similar, in its consistence, to the blood of persons who have been hanged, or destroyed by electricity.<br /><br />3d That the stomach, and beginning of the duodenum, are the parts that appear most diseased. In two persons who died of the disease on the 5th day, the villous membrane of the stomach, especially about its smaller end, was found highly inflamed; and this inflammation extended through the pylorus into the duodenum, some way. The inflammation here was exactly similar to that induced in the stomach by acrid poisons, as by arsenic, which we have once had the opportunity of seeing a person destroyed by it.<br /></span><br /><span style="font-style:italic;">The bile in the gall-bladder was quite of its natural colour though very viscid.<br /><br />In another person who died on the 8th day of the disease, several spots of extravasation were discovered between the membranes, particularly about the smaller end of the stomach, the inflammation of which had considerably abatted. Pus was seen in the beginning of the duodenum, and the villous membrane at this part was thickened.<br /></span><br /><span style="font-style:italic;">In two other persons, who died at a more advanced period of the disease, the stomach appeared spotted in many places with extravasations, and the inflammation disappeared. It contained, as did also the intestines, a black liquor, which had been vomited and purged before death. This black liquor appears clearly to be an altered secretion from the liver; for the fluid in all respects of the same quality was found in the gall bladder. The liquor was so acrid, that it induced considerable inflammation and swelling on the operator's hands, which remained some days. The villous membrane of the intestines, in these last two bodies, was found inflamed in several places.</span><br /><br /><span style="font-style:italic;">The liver was of its natural appearance, excepting in one of the last persons, on the surface of which a very few distended veins were seen; all the other abdominal viscera were of a healthy appearance.<br /><br />The external surface of the stomach, as well as of the intestines, was quite free from inflammation; the veins being distended with blood, which appeared through the transparent peritoneum, gave then a dark colour.<br /><br />The stomach of those who died early in the disease was always contracted; but in those who died at a more advanced period of it, where extravasations appeared, it was distended with air.<br /></span><br /><span style="font-style:italic;">P. S. Physick<br />J. Cathrall </span><br /><br />Cathrall continued to study the black bile that caused inflammation of his hand, and in a monograph published in 1794 concluded that it did not cause yellow fever.<br /><br /> <br /><br /> .Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0tag:blogger.com,1999:blog-1723495615431424809.post-24664624048389352502011-04-03T18:52:00.000-07:002011-04-18T08:08:31.800-07:00Timothy Pickering's Son<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/-7wVtqsmSYC0/TaxRkf_7eJI/AAAAAAAAZP4/tLmEVRV-WQQ/s1600/pickering.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 328px; height: 400px;" src="http://3.bp.blogspot.com/-7wVtqsmSYC0/TaxRkf_7eJI/AAAAAAAAZP4/tLmEVRV-WQQ/s400/pickering.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5596938124421462162" /></a><br />﻿Rush's first patient on Tuesday morning October 8 was Timothy Pickering's son. Earlier Pickering had written to a friend in Massachusetts that he had "such confidence in the safety of Dr. Rush's practice that my fear of the disease is greatly abated." He and his family were careful to follow Rush's strictures. "We eat largely of bread and vegetables, little or no butter, but molasses and honey instead thereof, barley soup, and very little meat. We drink no wine but use porter much diluted with water, tea, coffee and chocolate. And we are careful to keep the body gently open. Castor oil we find most convenient for this purpose, taken about once a week." Most people died, he thought, from want of care. "Many have been abandoned by their friends, and left in the hands of negroes and other ignorant mercenaries."<br /><br />A few days later a maid and his six year old son Edward got the fever. The maid recovered while groaning "loudly" about the purging and puking. After getting the same medicine, his son didn't recover, and "... he refused to take anything and in answer to his mother's importuning said his throat was stopped." Pickering wrote to Rush and asked if glysters were in order. That night mother and father administered three and at sunrise the boy passed a stool. The fourth glyster "was followed by several small evacuations," which seemed to relieve him. Then the boy puked dark matter. Before he had only puked while being bled. Pickering thought the "critical moment" had arrived and begged Rush to hasten his visit. Pickering and Rush did not record the last measures they tried before the boy died. Unlike a grocer who wrote to Rush blaming his daughter's death on "the drastic operation of the mercurial purges," Pickering did not blame Rush. Purging had saved his maid, and it appeared his son's obstinacy led to his death.<br /><br />At the time, Pickering was Postmaster General of the United States and his staying in the city helped assure that mail continued to be made available for people to pick up at the Post Office and that mail was sent out of the city. Many marked their letters "smoked" so that the recipient would deem it safe to open.<br /><br />Pickering later became Secretary of War and then Secretary of State. He joined in the discussion on how to prevent yellow fever and designed a system of docks for the new City of Washington that he thought would keep water from stagnating. He agreed with Benjamin Rush that the epidemics were caused in part by stagnant water. His designs were not used. The City of Washington never developed a port rivaling the size of the ports of Philadelphia, New York and Baltimore.Bob Arnebeckhttp://www.blogger.com/profile/15893961792819124892noreply@blogger.com0